February 03, 2018

Lately I've heard such horror stories about Dr Larry Nassar with hundreds of young women coming forward and saying he had violated them sexually. In the courtroom Nassar was forced to sit there and hear the women accuse him of being the devil incarnate. One of them said, "I will never trust another man again." After listening to all these accusations and with Nassar already sentenced to 175 years in jail, I got curious: what did this man actually do to them to elicit such hatred and condemnation? This was never discussed on the news.

After a little googling around I found out that Dr Nassar stuck his fingers in their vaginas thereby penetrating them. Sometimes there was anal penetration the same way. However, this was in the course of a pelvic exam during which it's entirely appropriate for the doctor to stick his fingers in a woman's vagina. Here's partly how Web MD describes a pelvic exam:

Perform a bimanual exam. Your doctor will place two fingers inside the vagina and uses the other hand to gently press down on the area he or she is feeling. Your doctor is noting if the organs have changed in size or shape.

Sometimes a rectal exam is performed. Your doctor inserts a gloved finger into the rectum to detect any tumors or other abnormalities.

Hmmm. It seems that a man penetrating a woman with his fingers during a pelvic exam is totally protocol. Dr Nassar evidently was the kind of doctor for whom a pelvic exam was within his training and capabilities. So why was there such an incredible amount of anger and acrimony over this? Well, the main thing seems to be that Nassar didn't wear gloves when performing the procedure. From a medical point of view this doesn't seem to be a big deal because sterile gloves are not required. The object of the exercise is to feel around for abnormalities. It's hard to see how Nassar using his ungloved hand would arouse him that much more than wearing a glove that would give him almost the same sense of tactile sensitivity. The vagina is not considered to be sterile so the contamination from Nassar's hands, provided he washed them first, should not have been a big deal.

Whether or not all these pelvic exams were absolutely necessary seems to be the crux of the matter, but there seems to be no criminality involved in overusing pelvic exams. The whole issue seems to boil down to the fact that Nassar did not wear gloves. Penetration by fingers is an appropriate part of a pelvic exam. So did Nassar get 175 years in jail and have to listen to being described as the lowest and most vile, reprehensible person who ever walked the face of the earth by a hundred women just because he didn't wear gloves during a pelvic exam?

Is this just another aspect of the #metoo hysteria? It seems that Dr Nassar should be cut some sort of slack, and the media is being entirely unfair to him if they can't describe exactly the difference between how he conducted a pelvic exam and how he should have conducted one.

Supporters of U.S. Sen. Bernie Sanders (I-VT) hold signs during an event on health care September 13, 2017 on Capitol Hill in Washington, DC. Sen. Sanders held an event to introduce the Medicare for All Act of 2017. (Photo: Alex Wong/Getty Images)

Amid the explosive anecdotal accounts contained in the new book, Fire & Fury: Inside the Trump White House by Michael Wolff, is an exchange between the president and top aides in which Trump reportedly demanded to know: "Why can't Medicare simply cover everybody?"

While fellow journalists have questioned Wolff's integrity as a reporter, and the White House has characterized his book as a work of "fantasy," the publisher has pushed up its release after Trump himself intervened with legal threats to block it from being release.

Despite that, Wolff apparently was given wide-ranging access, says he recorded many of his interviews with top staffers and insiders, and stands by the accounts contained in Fire & Fury. Speaking to NBC News on Friday morning, Wolff said he stands by "absolutely everything" reported in his book.

"My credibility," he said of Trump's attacks against him, "is being questioned by a man who has less credibility than perhaps anyone who has ever walked on Earth."

On the issue of healthcare, according to an excerpt, Wolff writes:

Trump had little or no interest in the central Republican goal of repealing Obamacare. The details of the contested legislation were, to him, particularly boring; his attention would begin wandering from the first words of a policy discussion. He would have been able to enumerate few of the particulars of Obamacare—other than expressing glee about the silly Obama pledge that everyone could keep his or her doctor—and he certainly could not make any kind of meaningful distinction, positive or negative, between the healthcare system before Obamacare and the one after.

That reporting, of course, largely betrays the fact that Trump repeatedly promised to repeal the Affordable Care Act (aka Obamacare) and supported numerous attempts by Republicans in Congress to do exactly that. By signing the "GOP tax scam" into law just before the Christmas holiday, Trump specifically bragged that a key component and victory of the legislation was its ending of the ACA's individual mandate—a provision that experts say will force an estimated 13 million people to lose their coverage.

However, while Trump is documented as knowing very little about how the ACA actually worked or healthcare policy overall, he has repeatedly let slip—both as a candidate and since taking office—that he perceives the wisdom of a system that covers everyone and even said explicitly at one point that "government's gonna pay for it."

In May of 2017, President Trump praised Australia as having "better healthcare" than Americans have in the United States, though it was unclear if he actually knew the Australians enjoy a single-payer system administered by the government.

And during the 2016 presidential campaign, Trump told 60 Minute's Scott Pelley that though it was a very "un-Republican thing for me to say," he would create a universal system which would "take care of everybody"—even those too poor to afford private insurance. Watch:

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"Instead of bragging about more Americans without health insurance, we should join every other major country on Earth, guarantee healthcare for all people, and end the absurdity of paying twice as much per capita for healthcare, as every other major nation," Sanders said. (Photo: CNN/Screengrab)

In an interview on CNN's "State of the Union" on Sunday, Sen. Bernie Sanders (I-Vt.) slammed President Donald Trump for "bragging" about a provision in the GOP tax bill that could throw 13 million Americans off their health insurance and argued that the U.S. should instead be working toward guaranteeing healthcare to all Americans as a right.

"Instead of bragging about more Americans without health insurance, we should join every other major country on Earth, guarantee healthcare for all people, and end the absurdity of paying twice as much per capita for healthcare as every other major nation," the Vermont senator said.

Sanders was reacting Trump's recent comments on the GOP tax bill's repeal of the Affordable Care Act's individual mandate. Trump claimed that the provision "essentially" repeals Obamacare, and insisted that he "will come up with something better."

The Republican Party's previous healthcare push, Sanders was quick to note, resulted in a bill that would have thrown more than 20 million Americans off their health insurance.

Sanders' remarks came in a wide-ranging interview in which he also denounced Trump for lying about who benefits from his tax plan and said Republicans should be "very" worried about their 2018 electoral prospects, given the deep unpopularity of their tax legislation.

"What we're seeing in Alabama, what we're seeing in Virginia, New Jersey and in states all across this country, are large voter turnouts, are people standing up and fighting back and demanding that we have a government that represents all of us, not just the one percent."

The Vermont senator also denounced Congress's lack of action to protect dreamers, calling it a "moral outrage."

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October 30, 2017

Think about it. We don't have a health care industry. We have a sick care industry. If everyone were healthy, there would be very little money involved with doctors and hospitals. X-Ray machines would just sit there useless. Ditto for MRI machines, CAT scan machines, infusion pumps and medical lasers. The only money would be in gym memberships and running shoes, and that's not all that much. Sure there would be some money in healing diseases caused by genetic malfunctions, but not enough for corporations to get involved. Even now pharmaceutical corporations are abandoning the development of new anti-biotics because there's no money in it. You use them a couple times, you get better and then stop using them. The real market is for drugs you use every day for the rest of your life like cholesterol and blood pressure medication.

It's the same with war. There's no money in peace, but there is an infinite amount of money in developing new high tech weaponry, new battleships, new airplanes, drones, surveillance equipment. As long as there's an enemy, there's a huge market for new military equipment. If peace broke out, well, there's no money in peace. There would maybe be an increase in tourism or consumption of educational or entertainment experiences, but nothing that would require a lot of money. Good food, various materials to enhance love making - not a lot of money involved compared to a B-2 Spirit at $737 million a copy. The B-2 Spirit can easily fly into enemy territory without being detected and deliver a damaging payload of bombs. Originally designed to carry nuclear explosives, the B-2 Spirit can now carry multitudes of bombs. No peace time activity could possibly command such a high price.

If we had a peace enhancement or a health enhancement industry, we'd be better off. Both expensive military equipment and expensive medical equipment play on peoples' fears more than anything else. We must be safe from enemy attack at all costs and safe from some disease that might kill us at all costs. We'd be better off if we promoted peace and good health for people everywhere in the world. That would entail clean water and foods devoid of herbicides, pesticides and artificial additives to make them look and taste better. But there's not a lot of money in that.

Ai-jen Poo, National Domestic Workers Alliance and the Caring Across Generations campaign: "The Maine campaign for universal in-home care could be the next big thing in the care movement. It could be a blueprint for the nation." (Photo: Courtesy of Inequality.org)

The key force behind the state’s progressive ballot initiatives, the Maine People’s Alliance, has just launched a campaign to put another landmark issue on the 2018 ballot: universal home care for the elderly and disabled.

There’s no question that such services are sorely needed — particularly in Maine, the state with the country’s highest median age. Caring for this rapidly aging population is extremely costly. The median annual cost for home care is now more than $50,000. That’s about on par with Maine’s median income for an entire household.

Medicare does not cover the costs of in-home care and Medicaid reimbursement rates are so low that employers have difficulty finding workers willing to do this tough work for the meager wages they offer.

Universal home care would be a huge relief for family members facing impossible choices between paying bills for basic needs versus covering the exorbitant cost of services for their loved ones.

The big question is: how to pay for it?

The Maine People’s Alliance proposal would raise the needed $132 million through a payroll tax increase of 1.9 percent on annual salaries and wages over $127,000 and a 3.7 percent tax on investment income above that same threshold.

In part, these taxes are designed to address the unfairness of the current cap on income subject to Social Security tax. That cap is now about $127,000, and so people who earn $1 million or even $100 million a year contribute no more to the nation’s pension fund than those making $127,001.

The ballot initiative proposal would also address the fact that in Maine, as in many other states, the wealthy pay a smaller share of their income on state and local taxes than low-income residents. Because of regressive sales and property taxes, Maine’s top 1% of earners pay only 7.5 percent of their income in state and local taxes, compared to 9.4 percent for families in the bottom 20% of the income scale, according to the Institute on Taxation and Economic Policy.

September 23, 2017

Funny how a diagnosis of brain cancer will tend to enhance your conscience and bring out your more compassionate side. It's twice now that Senator John McCain has foiled the Republican Party's attempt to deny health care to millions of people. His No vote on the latest attempt to "Repeal and Replace" Obamacare means that Obamacare will remain the law of the land until something better comes along. That something better could be Bernie Sanders' Medicare for All.

The Republican Party had nothing to offer in terms of a plan to Repeal and Replace Obamacare. It's just that the Repeal and Replace meme had been talked up for years by hate talk radio's Rush Limbaugh, Alex Jones and others Haters and hatchet jobs such as Ann Coulter had made a very nice living out of ginning up anger and hate throughout the US. The original meme was just Repeal, but some of the haters moderated that to Repeal and Replace. It turns out they had nothing to replace it with. The Republican effort was not to come up with a better health care system. It was just to cater to a hateful meme that had been shouted from the rooftops of hate talk radio and Fox news. Funny how much money there is to be made by hateful speech.

Sort of reminds me of the 30s in Germany. Hitler was one of the greatest hate talkers of all time renowned for his speaking ability and his ability to stir up an audience to where they were shouting the German equivalent of "Right On." Before Hitler stumbled into a German beer hall where the half dozen member Nazi club was assembled, the Nazis were no threat to anyone. They were a bunch of tired old men with no speaking ability among them. Then Hitler came along and revived them. Pretty soon a Munich beer hall was not big enough for the assembled throngs. They had to rent a stadium.

Now in 21st century America, there is not one Hitler type figure. There is a whole slew of surrogates dedicated to whipping up the hate among Americans who feel that immigrants have moved in and taken their jobs. Just as Hitler wanted to purify Germany by getting rid of the Jews who had taken their jobs, the Republican "base" wants to purify America by getting rid of the various ethnic minorities especially immigrants. Health care was only a symbol; Repeal and Replace was only a slogan. When it came right down to it, one Republican Senator, John McCain, put the kibosh on the Republican Party who wanted to patronize the hate talkers and their groupies all over America and also pass their real agenda of tax cuts for the rich. So what if 40 or 50 million Americans died an early death.

One Republican Senator, however, found his conscience after realizing that he personally had the best health care in the world and he personally was just as vulnerable as any other American. He couldn't stomach his own hypocrisy if he voted to deny health care to other less fortunate people. He alone didn't give in to the hate talkers of America. In the final analysis his humanity won out. He didn't want his legacy to be that he participated in the denial of decent health care to millions of people.

September 22, 2017

No Rest Rooms in Downtown San Diego Plus Thousands of Homeless Equals Hepatitis A Outbreak

by John Lawrence

What did they expect to happen? To be blunt people were living on the streets, the same streets tourists and residents were plodding down, and they were shitting and pissing all over the streets and sidewalks. I say again: what did they expect to happen? People were going to Padres games, spending hundreds of dollar on tickets, food, beverages and merchandise and they're walking over streets contaminated with human and animal waste products. Don't forget a lot of homeless people have pets. They had nowhere to go either.

San Diego didn't used to provide public rest rooms for anybody, much less the homeless. It's just that they couldn't afford to. They spend millions of dollars on everything else, but they couldn't afford public bathrooms. If you couldn't afford to patronize some profit making establishment where you could use the bathroom, you were just out of luck. You had to go in the bushes. That's just what thousands of homeless have done... and the sidewalks.

European cities provide public rest rooms on practically every corner, even the poorest cities. San Diego, by contrast, set up a Portland Loo and then decided that there was too much crime going on there and took it away. Most European public bath rooms have attendants who oversee the operation and make sure it stays clean and safe. Of course San Diego never thought of that. These European bathroom attendants were probably not paid very much, but at least they had a job. Suppose San Diego could afford that?

Now the LA Times reported that Los Angeles County health officials declared a hepatitis A outbreak, days after a public health emergency was announced in San Diego County, where at least 16 people have died of the highly contagious virus. It has been known for some time that the homeless were running up huge bills for taxpayers to pay at San Diego emergency rooms, but that and the extra costs for police were not enough to persuade local "leaders" to provide housing and sanitary living conditions for those who couldn't provide it for themselves. So public expense, public safety and now public health evidently are not enough motivation for the public to do something about the homeless situation. As has been pointed out, the City has the money in various funds, but it won't spend it on housing for the homeless.

Councilman David Alvarez, one of the memo’s co-authors, said the city is sitting on “literally hundreds of millions of dollars” it could spend on housing.

“Unfortunately, the mayor has refused to take action on this issue,” Alvarez said. “We are seeing more and more money coming back to the city in the general fund. ... This was intended to be used for more housing and it hasn’t been.

“You’d have to ask the Mayor’s Office why they don’t want to use it for that purpose.”

Katheryn Rhodes and I did a series of articles on money the City of San Diego has squirreled away in the LMIHAF fund and other funds that it is supposed to use for affordable housing but won't do it. Something like $30 million altogether. It seems the Mayor doesn't want his reputation tarnished by catering to the homeless. It would be unseemly. So tourists and downtown residents living in million dollar condos will just have to take the Hepatitis A risk on themselves.

September 19, 2017

Berniecare: The Only Rational and Cost Effective Alternative for Health Care in the US

by John Lawrence

Will the American people listen to reason regarding health care? If so Berniecare could be the next health care policy in the US. It would be the best health care system in the entire world - bar none. Bernie has been touting "Medicare for All" for years. Health care should be a right not a privilege, the way it is in most civilized countries of the world. Universal health care is certainly as important as universal education if not more so. Bernie now has 17 Senate co-sponsors on his bill which is 17 more than he had a year ago - Elizabeth Warren of Massachusetts, Kamala Harris of California, Kirsten Gillibrand of New York and Cory Booker of New Jersey.

Bernie's plan will cover dental and vision care which are not covered by conventional insurance plans. It will cover prescription drugs and bring their cost down because of the government's immense bargaining power. It will cover nursing home care which isn't covered by Medicare now. It will do all this for far less money than is being spent on health care now. America spends far more on health care than any single payer country, and the results are more meager by any standard or measure.

There will be no co-pays and no deductibles. You will be able to go to any doctor or hospital and simply present your insurance card, the way it is in Canada now. Last year, the average working family paid $4,955 in premiums and $1,318 in deductibles to private health insurance companies. Under this plan, a family of four earning $50,000 would pay just $466 per year to the single-payer program, amounting to a savings of over $5,800 for that family each year.

The United States currently spends $3 trillion on health care each year—nearly $10,000 per person. Reforming our health care system, simplifying our payment structure and incentivizing new ways to make sure patients are actually getting better health care will generate massive savings. This plan has been estimated to save the American people and businesses over $6 trillion over the next decade.

The American people will clearly be the winners if Berniecare is implemented. So who will be the losers? The insurance companies, the pharmaceutical corporations even for profit hospitals who will be forced to bring their costs under control. Doctors who take payoffs from pharmaceutical corporations will lose too. So their lobbyists will work overtime to make sure Berniecare never happens.

Let's hope that more influential people including politicians, celebrities and billionaires get behind Berniecare. Let's get it implemented. Let's get the next President of the US to be someone who is fully behind Berniecare. It will restore the US as one of the world's leading nations. Or we can stick with the abortion of health care we have now.

Possibly even Trump could get behind Berniecare. He's a renegade from traditional Republican orthodoxy. It could happen, but don't hold your breath.

August 03, 2017

There are two and only two things they need to stand for: 1) Medicare for All and 2) Free College Education. These are the two major domestic issues facing Americans today. These are bread and butter issues that every American can relate to. These are issues which will normalize the economic system which is based on student loan debt and health insurance which is sucking the economic life out of the middle class.

How to Pay for Free College Tuition and Reasonably Priced Health Care: Tax the Uber Rich

At the same time this will accomplish the additional desirable goal of decreasing the economic divide. All the gains since 2008 have gone to the upper 1%. The middle class and the poor are losing out while the rich become billionaires. They are forming themselves as an oligarchy and a plutocracy. They are using their money to control the political system. We need to get lobbyists (especially lobbyists for the pharmaceutical corporations) out of Washington and replace them with lobbyists for the middle class.

The Republican Base Has Been Hornswoggled

They believed all the BS they've been fed by hate talk radio, Fox news, Rush Limbaugh, Alex Jones and others. These talk show hosts are just shills for the rich of whom they are ones themselves. When the red meat states wake up and realize they've been screwed, they will vote for the Democrats, or perhaps another party if the Democrat brand is too tainted already, that promises and will deliver to them free college education and/or apprenticeship training and Medicare for all WITH COST CONTROLS.

July 28, 2017

Senate Republicans attempted to pass a “skinny repeal” bill that would undo some portions of the Affordable Care Act on July 28, but the bill failed after three GOP senators voted against it. (Photo: Melina Mara/The Washington Post)

Sen. John McCain (R-Ariz.) was the third Republican to vote against a "skinny" Obamacare repeal bill last night, ending the Republican health-care effort for now. (Photo by Melina Mara/The Washington Post)Republicans' seven-year quest to wipe out President Obama's Affordable Care Act came to a crashing halt around 1:30 this morning, when Sen. John McCain (R-Ariz.) shockingly bucked his party and voted against a scaled-down repeal bill that emerged as the Senate's last-ditch effort. It's now clear that replacing Obamacare -- or even repealing small parts of it -- may be forever a pipe dream for President Trump and the GOP, whose deep divisions over the U.S. health-care system proved unbridgeable in the end.

Gasps broke out around the Senate chamber early this morning as McCain walked to the dais and uttered "no" on the "skinny repeal" bill. Two other Republicans -- Sens. Susan Collins of Maine and Lisa Murkowski of Alaska -- had already opposed it, making McCain the third GOP no vote and the senator to ultimately sink the measure. It was a surreal scene; until the end, McCain wasn't among the senators expected to defect. Earlier this week, McCain made a quick return visit to Capitol Hill after surgery related to his recent diagnosis of brain cancer to help Republicans start health-care debate, for which Trump had praised him warmly. This seems oh-so-long ago, already.

July 27, 2017

"We really are in a fight for our lives. Yet we’re motivated not just by fear but also by moral outrage. We know how fundamentally wrong it is to deprive people of health care." (Photo: CSPAN)

On Tuesday, 50 Republican senators showed contempt for their constituents by voting to move forward on repealing our health care, with Vice President Mike Pence stepping in to break the tie.

Nine GOP senators later broke ranks in a late-night session to vote down the Senate’s toxic version of the bill, the Better Care Reconciliation Act (BCRA) – which would have rolled back much of the Affordable Care Act and gutted Medicaid, ending coverage for 23 million – but there are more votes to come, including one that may simply repeal care and and strip coverage from 32 million.

GOP leaders will want the new version to look just like their previous versions: cut taxes for corporations and the rich, raise the price of coverage for the rest of us, unravel Medicaid, and take health care from 22 to 24 million people.

Ohio’s Sen. Rob Portman also caved, representing a state where hundreds of thousands of people finally got coverage because of expanded Medicaid under the Affordable Care Act.

It was extremely irresponsible of Portman, Capito, and Heller – who have all expressed concern for constituents enrolled in Medicaid – to throw their weight behind this reckless process without a clear plan for protecting Medicaid coverage.

They need to show this is more than talk. Now more than ever, their constituents need them to stand strong, resist any bullying, and protect Medicaid and health care overall. They’ll do that, if they really do care about their constituents.

Like these heroes, tens of thousands of people have shown up at protests and town halls, often speaking up for the first time in their lives. In every corner of the country, people have put their senators on speed-dial, camped out in congressional offices, and rallied friends.

We really are in a fight for our lives. Yet we’re motivated not just by fear but also by moral outrage. We know how fundamentally wrong it is to deprive people of health care.

And our fight isn’t over. Republican leaders wanted to put health care repeal on Trump’s desk in January. It’s the end of July, they’re still scrambling. That’s because of us.

In the coming days, let’s keep making calls and showing up at rallies and protests. Let’s track every vote this week, and raise the pressure on senators and representatives alike if repeal moves to a conference committee.

We’ve shown an incredible persistence in our fight. We’ll show plenty more when it comes to holding politicians accountable for a vote that favors big-money bullying over the people they’re supposed to represent.

July 26, 2017

Senate Republicans don’t exactly know how they’re going to rip health care away from tens of millions of Americans – but they voted for it anyway today.

This vote isn’t just irresponsible. It isn’t just reckless. It isn’t just cruel.

This vote is immoral. It goes against everything we stand for in this country – and everything we stand for as Americans.

But this fight isn’t over – not by a long shot. We still have time to stop the final passage of this bill. We can still stop the Republicans from gutting Medicaid and taking away millions of Americans’ health care so that America’s richest families can get a tax break.

We’re not going to whimper. We’re not going to whine. We’re going to fight back. All of us, including you, John.

History will judge us for what happens in the United States Senate this week. This is the week we must prove: the Senate doesn’t just work for the billionaires and giant corporations, it doesn’t just work for the lawyers and lobbyists, and it doesn’t just work for one bought-and-paid-for political party – it works for the people.

If they were, they would design a health care system that was the best in the world with input from people that really know what they're doing. Instead we're getting a mish mash designed by lobbyists who only care about health care from the perspective of how much money they can make off it. Republicans want health care to represent the interests of the most powerful corporations and individuals in America, and that means that the final design, if they can come up with one, will serve the interests of politicians and lobbyists.

These Senators don't know crap about what health care is all about or should be all about. They are lusting after a transfer of wealth to higher net worth individuals by lowering taxes that represent a transfer of wealth to lower income individuals.

They see Obamacare as a transfer from the rich to the poor in the form of Medicaid. If they got health care costs under control, there wouldn't be a need for any transfers between economic classes whatsoever, but lobbyists for pharmaceutical corporations and other health care corporations don't want costs under control. That would mean decreased profits for them.

How does the rest of the world provide health care for a reasonable cost for all their citizens? Maybe the politicians should look into that. Instead, their focus is on how to buy a few votes by granting special favors to a few Senators whose votes they need to pass legislation that will screw the poor.

July 22, 2017

There's a reason why American medical care is so expensive: It benefits the bottom lines of major American corporations. Medicare for all would be much cheaper in terms of overall costs that would be paid by means of taxation primarily. However, GDP would decline as major corporations' profit margins would decrease. The system we have right now allows the bilking of the American people through the tax code and directly through their pocketbooks. Medicare for all would lower the net out of pocket costs to the average American citizen and result in better health care for all. The big gainers would be the American people. The big losers would be American corporations and the American economy as a whole which doesn't produce much except high cost medical care and financial derivatives. Pharmaceutical lobbyists and compliant Republican lawmakers will do all they can to keep the current system which guarantees huge profits to these corporations. Their lobbyist expenditures are a minimal investment that guarantees maximal profits at the expense of the average American.

Obamacare, Trumpcare, Repeal and Replace - all this stuff is a bunch of hooey. The issue is what is the best form of health care at the least expense for the American people. The Democratic party should redefine itself along these lines and stand for Medicare for All. The candidate that does that will win the next election. For too long Republicans and their talk show surrogates have pulled the wool over the eyes of the American people.

"There is a significant increase in people who support universal coverage," Robert Blendon of the Harvard T.H. Chan School of Public Health told AP. (Photo: Molly Adams/Flickr/cc)

In the face of "cruel" attempts by the Republican Party to strip health insurance from more than 30 million Americans with the goal of providing massive tax breaks to the wealthy, a new poll published on Thursday finds that a growing majority of the public is "shifting toward the political left" on healthcare and expressing support for a system that ensures coverage for all.

"The Democratic party needs to stop fumbling around incompetently for a positive vision and instead unify behind the one already supported by the overwhelming majority of its voters." —Matt BruenigThe poll, conducted by the Associated Press in partnership with the NORC Center for Public Affairs Research, shows that 62 percent of public believes it is "the federal government's responsibility to make sure that all Americans have health care coverage."

As AP's Ricardo Alonso-Zaldivar and Laurie Kellman note, this is a dramatic shift in popular attitudes over a very short period of time.

"As recently as March," they observe, "the AP-NORC poll had found Americans more ambivalent about the federal government's role, with a slim 52 percent majority saying health coverage is a federal responsibility, and 47 percent saying it is not."

This most recent poll also found:

Only 22 percent of Democrats want to keep Obamacare as it is, and 64 favor changes to the law.

80 percent of Democrats believe it is the federal government's responsibility to ensure coverage for all.

80 percent of Americans believe Republicans should work with Democrats to improve Obamacare.

These latest survey results are consistent with increasingly vocal grassroots support for a Medicare-for-All style system that "leaves no one out." Prominent Democrats have joined the groundswell of enthusiasm; former Vice President Al Gore and Sen. Elizabeth Warren (D-Mass.) are two of the more notable figures who have openly advocated a move toward single-payer in recent weeks.

"There is a significant increase in people who support universal coverage," Robert Blendon of the Harvard T.H. Chan School of Public Health told AP. "The impact of the debate over dropping coverage looks like it has moved [more] people to feel that the government is responsible for making sure that people have coverage."

This soaring support for Medicare for All at the grassroots has been bolstered by recent analyses showing that a single-payer system would be more affordable than the current for-profit system—a fact that refutes President Donald Trump's baseless claim on Wednesday that single-payer would "bankrupt our country."

All of these factors, argues welfare policy analyst Matt Bruenig in a recent piece for Buzzfeed, amount to an irrefutable case in favor of moving beyond Obamacare to a healthcare system that ensures universal coverage.

"Now that the Republicans have failed [in their attempts to repeal Obamacare], the time is ripe for a serious single-payer push," Bruenig writes. "Policy institutions need to work hard to hammer out the details of a single-payer plan, and the Democratic party needs to stop fumbling around incompetently for a positive vision and instead unify behind the one already supported by the overwhelming majority of its voters."

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Gore is the latest prominent Democrat to come out in favor of single-payer in the midst of Republican attempts to dismantle the Affordable Care Act. (Photo: Dan Farber/Flickr/cc)

On the heels of what appeared to be Trumpcare's final collapse on Monday and in the midst of growing grassroots demands for Democratic lawmakers to embrace a "bold" agenda, former Vice President Al Gore said at an event on Tuesday that he believes the United States should move toward a single-payer system that guarantees healthcare for every American.

"I believe we ought to have single-payer healthcare." —Al Gore"The private sector has not shown any ability to provide good, affordable healthcare for all," Gore said at Borough of Manhattan Community College, where he was promoting his new climate change documentary. "I believe we ought to have single-payer healthcare."

As the Huffington Post's Alexander Kaufman notes, Gore has in the past unenthusiastically expressed support for single-payer.

"I think we've reached a point where the entire healthcare system is in impending crisis," Gore said in 2002. "I have reluctantly come to the conclusion that we should begin drafting a single-payer national health insurance plan."

Gore is one of the most prominent Democrats to speak publicly in support of a Medicare-for-All type system as Republicans attempt to move ahead with their long-shot effort to repeal Obamacare without a replacement. Others who have recently endorsed single-payer include Sen. Elizabeth Warren (D-Mass.) and Sen. Kamala Harris (D-Calif.).

Bernie Sanders spoke in Des Moines, Iowa on Saturday where he issued a rallying cry for "a vibrant American democracy," and took aim at the Republicans' healthcare bill, which he called "the most anti-working class legislation" in modern history.

The Vermont senator made the remarks at the Iowa Citizens for Community Improvement (CCI) Action Fund's annual convention called "Revolution Iowa: From Protest to Power," where he delivered the keynote address.

he trend toward having a handful of billionaire families with unlimited resources controlling our political process will only get worse. The trend toward a handful of conglomerates owning and controlling our economy will only get worse."

"And what our job is," he continued, "is to create a vibrant democracy where one person, one vote is what dominates the political system, not billionaires buying the election."

"Democracy is facing an enormous challenge," Sanders said.

Threats to a "vibrant democracy," he said, come not only from the "disastrous" Citizens United Supreme Court ruling, but also "Republican governors, cowardly governors, who don't have the guts to run for office based on their ideas but who are attempting to suppress the vote to keep low-income people or people of color or working people or older people from participating in the political process."

"If some Republican wants to run for office talking about giving tax breaks to billionaires and cutting Social Security and Medicare and Medicaid and education, that is his or her prerogative. Run for office on those ideas. See how many votes you get."

His advice for politicians espousing those ideas but not willing to run for office on them? "Get out of office or get another job."

Among the steps to ensure that everyday Americans—"not the Koch brothers"—dominate the political process, Sanders said, are establishing automatic voter registration, restoring the voting rights for convicted felons who've served their sentence, ending superPACs, and enacting public funding of elections.

Sanders also took direct aim at Donald Trump, saying the president's claim that three to five million people voted illegally in the 2016 presidential election "is an absolute lie" whose goal is "to encourage state officials all across the country to suppress the vote. We will not accept that."

Trump, he added, "is supporting the most anti-working class legislation ever presented in the modern history of this country—a disastrous healthcare bill."

"President Trump, don't tell the people of this country that you support the working class when you are defending legislation which will throw 22 million Americans off of the healthcare they currently have," Sanders said. "That is not defending the working class. That is a major attack on middle class and working-class families all across this country."

Addressing his Senate colleagues in the Hawkeye State, Republicans Chuck Grassley and Joni Ernst, he said, "please, please take a hard look at what this disastrous legislation will do to the people of Iowa and the people of America."

"I beg of them: please vote 'no' on this legislation," Sanders said.

The former presidential candidate, who last week said a 2020 White House bid wasn't "off the table," told the crowd: "We are going to fight for an American democracy that will make future generations proud."

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WASHINGTON — President Trump and congressional Republicans, despite repeated pledges to preserve sick Americans’ access to health coverage, are poised to scrap this core insurance protection in their campaign to roll back the Affordable Care Act.

Both the House GOP bill that passed in May and the revised Senate GOP bill unveiled last week essentially eliminate the coverage guarantee by allowing health insurers to once again sell skimpier plans and charge more to people with preexisting health conditions who need more-comprehensive coverage.

At the same time, the House and Senate bills dramatically scale back financial aid to low- and moderate-income consumers and slash funding for Medicaid, the government safety-net plan that has helped millions of sick and poor Americans gain coverage.

That combination — looser insurance requirements and less financial assistance for patients — will once again put health plans out of reach for millions of sick Americans, according to numerous analyses.

“The fundamental guarantee at the heart of the Affordable Care Act was that people who are sick can get insurance at the same price as everyone else,” said Larry Levitt, an insurance market expert at the nonprofit Kaiser Family Foundation. “The House and Senate replacement bills move the system back to a place where healthy and sick people are treated very differently.”

July 14, 2017

WASHINGTON, DC - MAY 04: Activists hold signs during a Stop 'Trumpcare' rally May 4, 2017 in front of the Capitol in Washington, DC. Congressional Democrats joined activists for a rally to urge not to replace Obamacare, also known as the Affordable Care Act. (Photo by Alex Wong/Getty Images)

As dozens of protestors led by Reverend William Barber crowded the halls of the Capitol and labeled the GOP's healthcare agenda "political murder," Senate Republicans on Thursday unveiled a new version of their Trumpcare plan that one critic mockingly described as "new and improved total garbage."

"The new Trumpcare bill is awful by design. The tool we have to fight it is simple: public pressure on senators." —Ezra Levin, IndivisibleThe newly released plan leaves massive and widely condemned Medicaid cuts intact while adding a new amendment—put forth by Sen. Ted Cruz (R-Texas)—that would allow insurers to offer cheap "bare-bones" plans which would wipe out a range of protections for all patients and specifically harm those with preexisting conditions.

CNN further noted that keeping the Medicaid cuts in place means "15 million fewer people could insured by the program by 2026" if Trumpcare becomes law.

Aside from the injection of extra funds aimed at appeasing so-called "moderate" Republicans who expressed concern that the bill does not do enough to address the opioid epidemic, Senate Majority Leader Mitch McConnell appears to be committed to keeping the most destructive elements of the bill in place, analysts observed.

One lobbyist told Vox's Dylan Scott that McConnell seems intent upon "going right rather than center."

"I knew this bill was unfixable. What I didn't count on was that it would get worse." — Andy Slavitt, former acting administrator of Medicare and Medicaid

As a result, at least one skeptical Republican Senator—Susan Collins of Maine—has already signaled that she will likely vote against a motion to proceed with the legislation, while several others remain undecided. If the bill is to pass, McConnell can only afford to lose two votes.

"I knew this bill was unfixable," concluded former acting administrator of Medicare and Medicaid Andy Slavitt. "What I didn't count on was that it would get worse."

"Don't fall for McConnell's trap. The new Trumpcare bill is awful by design, but it's not doomed. It's not the final version," wrote Ezra Levin, co-executive director of Indivisible. "The tool we have to fight it is simple: public pressure on senators."

Sen. Bernie Sanders (I-Vt.), who spent this past weekend rallying the Trumpcare opposition in West Virginia and Kentucky, reiterated a point he has made frequently in recent months.

"Make no mistake about it," he wrote, "thousands of Americans every year will die unnecessarily if the Republican legislation is passed."

Topher Spiro, a senior fellow at the Center for American Progress, marked up Cruz's amendment to demonstrate how disastrous it would be for consumers.

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July 13, 2017

The introduction of the Republican legislation to “repeal and replace” Obamacare is no more than latest scrimmage in the ongoing one-sided war against the poor and working class. The “Affordable Care Act” (ACA, better known as Obamacare) proved to be both unaffordable and unable to provide comprehensive care for millions. Nevertheless, with the ACA being one of the only tangible “victories” Democrats could claim for an administration with a dismal record of noteworthy accomplishments, neoliberal Democrats and the party’s liberal base led by Bernie Sanders are now coalesced around the ACA and have vowed to defend it to the bitter end.

Yet, camouflaged by the hot rhetoric of confrontation and the diversionary struggle of the duopoly, the common agenda and objective interests being protected in this healthcare battle are quite clear. No matter what version of the healthcare bill passes or if the ACA remains in place, it will be a win for the market-based, for-profit beneficiaries of the U.S. system. As long as healthcare remains privatized, the real winners of healthcare reform will continue to be the insurance companies, hospital corporations and pharmaceutical and medical device companies.

That commitment to the interests of the insurance/medical complex ensures that the interests of healthcare consumers, the uninsured, the elderly and the sick will continue to be sacrificed to maintain a healthcare delivery system in which thousands suffer premature deaths from inadequate preventative treatment, millions are unable to afford coverage and millions who have private insurance fear using it because of prohibitive co-pays and deductibles.

July 02, 2017

NOW’S THE TIME FOR MEDICARE FOR ALL

As Republicans in Congress move to repeal the Affordable Care Act, Democrats are moving in the opposite direction, toward Medicare for All – a single-payer plan that builds on Medicare and would cover everyone at far lower cost.

Most House Democrats are already supporting a Medicare for All bill. Senator Bernie Sanders is preparing to introduce it in the Senate. Both California and New York state are moving towards single-payer plans.

With health care emerging as the pubic’s top concern, according to recent polls, the choice between repeal of the Affordable Care Act and Medicare for All is likely to be the major domestic issue in the presidential campaign of 2020 (other than getting Trump out of office, if he lasts that long).

And the better choice is clear. Private for-profit insurers spend a fortune trying to attract healthy people while avoiding the sick and needy, filling out paperwork from hospitals and providers, paying top executives, and rewarding shareholders.

And for-profit insurers are merging like mad, in order to make even more money.

These are among the major reasons why health insurance is becoming so expensive, and why almost every other advanced nation – including our neighbor to the north – has adopted a single-payer system at less cost per person and with better health outcomes.

Most Americans support Medicare for All. According to a Gallup poll conducted in May, a majority would like to see a single-payer system implemented.

An April survey from the Economist/YouGov showed 60 percent of Americans in favor of “expanding Medicare to provide health insurance to every American.” That includes nearly half of people who identify themselves as Republican.

If Republicans gut the Affordable Care Act, the American public will be presented with the real choice ahead: Either expensive health care for the few, or affordable health care for the many.

June 28, 2017

Mitch McConnell is delaying a vote on the Senate Republican version of Trumpcare because he doesn’t yet have a majority.

Some Senate Republicans think the bill doesn’t go get rid of enough of the Affordable Care Act. Others worry that it goes too far – especially in light of the Congressional Budget Office’s finding that it would eliminate coverage for 22 million Americans.

What should be the Democrats’ response? Over the next weeks or months, Democrats must continue to defend the Affordable Care Act. It’s not perfect, but it’s a major step in the right direction. Over 20 million Americans have gained coverage because of it.

But Democrats also need to go further and offer Americans a positive vision of where the nation should be headed over the long term. That’s toward Medicare for all.

Some background: American spending on healthcare per person is more than twice the average in the world’s thirty-five advanced economies. Yet Americans are sicker, our lives are shorter, and we have more chronic illnesses than in any other advanced nation.

That’s because medical care is so expensive for the typical American that many put off seeing a doctor until their health has seriously deteriorated.

Why is healthcare so much cheaper in other nations? Partly because their governments negotiate lower rates with health providers. In France, the average cost of a magnetic resonance imagining exam is $363. In the United States, it’s $1,121. There, an appendectomy costs $4,463. Here, $13,851.

They can get lower rates because they cover everyone – which gives them lots of bargaining power.

Other nations also don’t have to pay the costs of private insurers shelling out billions of dollars a year on advertising and marketing – much of it intended to attract healthier and younger people and avoid the sicker and older.

Nor do other nations have to pay boatloads of money to the shareholders and executives of big for-profit insurance companies.

Finally, they don’t have to bear the high administrative costs of private insurers – requiring endless paperwork to keep track of every procedure by every provider.

According to the Kaiser Family Foundation, Medicare’s administrative costs are only about 2 percent of its operating expenses. That’s less than one-sixth the administrative costs of America’s private insurers

To make matters even worse for Americans, the nation’s private health insurers are merging like mad in order to suck in even more money from consumers and taxpayers by reducing competition.

At the same time, their focus on attracting healthy people and avoiding sick people is creating a vicious cycle. Insurers that take in sicker and costlier patients lose money, which forces them to raise premiums, co-payments, and deductibles. This, in turn, makes it harder for people most in need of health insurance to afford it.

This phenomenon has even plagued health exchanges under the Affordable Care Act.

Medicare for all would avoid all these problems, and get lower prices and better care.

It would be financed the same way Medicare and Social Security are financed, through the payroll tax. Wealthy Americans would pay a higher payroll tax rate and contribute more than lower-income people. But everyone would win because total healthcare costs would be far lower, and outcomes far better.

If Republicans succeed in gutting the Affordable Care Act or subverting it, the American public will be presented with a particularly stark choice: Expensive health care for the few, or affordable health care for the many.

This political reality is already playing out in Congress, as many Democrats move toward Medicare for All. Most House Democrats are co-sponsoring a Medicare for All bill there. Senator Bernie Sanders is preparing to introduce it in the Senate. New York and California are moving toward statewide versions.

A Gallup poll conducted in May found that a majority of Americans would support such a system. Another poll by the Pew Research Center shows that such support is growing, with 60 percent of Americans now saying government should be responsible for ensuring health care coverage for all Americans – up from 51 percent last year.

Democrats would be wise to seize the moment. They shouldn’t merely defend the Affordable Care Act. They should also go on the offensive – with Medicare for all.

June 27, 2017

Facing intransigent Republican opposition, Senator Mitch McConnell of Kentucky, the Republican leader, has told senators he will delay a vote on his legislation to repeal the Affordable Care Act, dealing President Trump an embarrassing setback on a key part of his agenda.

WASHINGTON — The Senate bill to repeal the Affordable Care Act was edging toward collapse on Monday after the nonpartisan Congressional Budget Office said it would increase the number of people without health insurance by 22 million by 2026.

Two Republicans, Senators Susan Collins of Maine and Rand Paul of Kentucky, said Monday that they would vote against even debating the health care bill, joining Senator Dean Heller of Nevada, who made the same pledge on Friday. Senator Ron Johnson of Wisconsin hinted that he, too, would probably oppose taking up the bill on a procedural vote expected as early as Tuesday, meaning a collapse could be imminent.

Ms. Collins wrote on Twitter on Monday evening that she wanted to work with her colleagues from both parties to fix flaws in the Affordable Care Act, but that the budget office’s report showed that the “Senate bill won’t do it.”

The report left Senator Mitch McConnell of Kentucky, the majority leader, with the unenviable choices of changing senators’ stated positions, withdrawing the bill from consideration while he renegotiates, or letting it go down to defeat — a remarkable conclusion to the Republicans’ seven-year push to repeal President Barack Obama’s signature domestic achievement.

The Senate’s bill to repeal the Affordable Care Act is not a healthcare bill. It’s a tax cut for the wealthiest Americans, paid for by a dramatic reduction in healthcare funding for approximately 23 million poor, disabled, and working middle class Americans.

America’s wealthiest taxpayers (earning more than $200,000 a year, $250,000 for couples) would get a tax cut totaling $346 billion over 10 years, representing what they save from no longer financing healthcare for lower-income Americans.

That’s not all. The bill would save an additional $400 billion on Medicaid, which Mitch McConnell, Paul Ryan, and Donald Trump are intent on shrinking in order to cut even more taxes for the wealthy and for big corporations.

If enacted, it would be the largest single transfer of wealth to the rich from the middle class and poor in American history.

This disgrace is being proposed at a time when the nation’s rich own a higher percentage of the nation’s wealth and receive the highest percent of America’s income since the era of the Robber Barons of the late nineteenth century.

Almost all of the transfer is hidden inside a bill that’s supposed to be a kinder and gentler version of its House counterpart, which Trump called “mean, mean, mean.”

Healthcare activists hold signs during a protest against the Trumpcare bill on June 21, 2017 in San Francisco, California. Dozens of healthcare activists and senior citizens staged a protest outside the San Francisco Federal Building to express their opposition of the American Heathcare Act bill that is being drafted behind closed doors by Republican senators. (Photo by Justin Sullivan/Getty Images)

"It's exactly what you'd expect from 13 Republican men and a bunch of lobbyists." —Rep. Barbara Lee (D-Calif.)The bill is not yet in its final form and, according to reports, Senate Majority Leader Mitch McConnell is still considering input from corporate lobbyists, but the contents released online have already sparked a flood of alarmed criticism, vows of opposition, and protests outside of McConnell's office.

Provides significant room for states to impose work requirements on Medicaid recipients

Though many Republicans have expressed hesitation about backing a deeply unpopular piece of legislation that would have a devastating impact on many of their constituents, McConnell has remained insistent upon bringing Trumpcare—which Senate Republicans have formally labeled the Better Care Reconciliation Act—to the floor for a vote next week.

Commentators and activists summarized the bill in much the same way they had in the weeks leading up to its release due to the fact that, as the Washington Postnotes, it "largely mirrors the House measure."

Both, if enacted, would rapidly alter the structure of the American healthcare system and increase, by tens of millions, the number of people without insurance.

"Trumpcare doesn't just repeal Obamacare," political analyst Stephen Wolf observed. "It repeals the last 52 years of advances in healthcare policy."

Faiz Shakir, the national political director of the American Civil Liberties Union (ACLU), argued in a statement the legislation would "endanger the lives and liberty of many Americans."

Shakir continued:

Heartless! Now we know why Senate Republicans have done everything they can to hide the contents of their health care repeal bill from the American people. By eviscerating Medicaid, this bill threatens the liberty of people with disabilities, who will be forced to live in nursing homes and institutions instead of their own homes. By defunding Planned Parenthood, this bill threatens the health of 2.5 million women and men in our country, many of whom rely on the health centers as their only source of care. And by throwing tens of millions of people off their insurance, this bill disproportionately impacts communities of color who will lose access to care and coverage.

In a blog post on Thursday, Indivisible co-executive directors Ezra Levin and Leah Greenberg deemed the bill "cruel" and "ugly," and outlined an action plan for those looking to resist its passage.

"Heartless! Now we know why Senate Republicans have done everything they can to hide the contents of their health care repeal bill from the American people." —Faiz Shakir, ACLU national political director

"We are under no illusions that victory is assured here," they concluded, "but victory is possible."

Democratic lawmakers, who in recent days have responded to grassroots pressure by vowing to forcefully oppose the legislation, were also quick to respond to the plan's release.

Senator has read Republican's bill and says it makes very clear who it aims to serve

"This bill does not represent our values," said Sen. Elizabeth Warren (D-Mass.). "This bill is not who we are as a country. We believe that health care is a basic human right, and we will get out there and fight for it." (Photo: Screenshot/@SenWarren)

Sen. Elizabeth Warren (D-Mass.) has now read the Republican bill that would repeal and replace the Affordable Care Act and says that it contains "one flashing neon light after another" that signals who this piece of legislation is designed to serve: the very rich and the very powerful.

"This is blood money," the senator said both on the floor of the Senate on Thursday and in a video posted to social media. "They're paying for tax cuts with American lives."

As critics have noted, the Republican effort to destroy the ACA, also known as Obamacare, should be seen not as an effort to provide better health coverage for Americans but as an opportunity to give the wealthy a major tax cut. Analysis shows that both the House and Senate versions of Trumpcare would strip coverage from millions and would make existing insurance policies worse and more expensive for nearly all Americans.

With massive cuts to Medicaid, the defunding of Planned Parenthood, and the end of vital protections for those with pre-existing conditions—Warren said there is no question about who will be harmed and who will be helped if the Republicans' proposals are not stopped.

"This bill does not represent our values," Warren said. "This bill is not who we are as a country. We believe that healthcare is a basic human right, and we will get out there and fight for it."

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June 22, 2017

The Republicans revealed their till now secretive replacement for Obamacare: Obamacare except less money for the poor. After making a super big deal out of "Repealing and Replacing" Obamacare for years and basing all their political fortunes on that, the best they can come up with is slashing Medicaid and other subsidies for the poor, a lot of them in Rust Belt states, which have faithfully voted for the anger based Republican party which has been helped along with the likes of Alex Jones, Rush Limbaugh and Fox news.

Libertarian-leaning Sen. Rand Paul of Kentucky, whose vote may be tough for McConnell to get, raised concerns about keeping income-based subsidies. “There’s a great danger, from the point of view of somebody who thought we were repealing Obamacare, that we’re going to actually be replacing Obamacare with Obamacare,” Paul said Wednesday.

Trump will probably tout the plan as "Really great health care. So much better than Obamacare. This is the best ever health care. Really great. We have made health care in America great again." Well, just not for the poor who are losing right and left in the Trump administration, but at least they've vented their anger against Obamacare and now they will have to live with the consequences. I guess there will be no more money for opioid treatment centers.

Republicans are counting on the fact that low information voters will just be too dumb to figure out that they're getting screwed and just take heart that their tribe, the Red State tribe, has done it again, given the finger to all those commy, latte drinking liberals in New York and California.

New financial analysis shows California's SB 562 would cut state spending on healthcare by almost 20 percent as new poll shows 7 in 10 voters support universal coverage plan

New analysis adds fuel to an ongoing debate over the costs of insuring all Californians—a debate sure to reverberate nationally. (Photo: National Nurses United/Flickr/CC)

In addition to a new poll showing it would be extraordinarily popular, California's single-payer bill—the Healthy California Act—would also cut costs while providing coverage for all.

That is the conclusion of a new analysis (PDF) published on Wednesday by the Political Economy Research Institute (PERI).

"We estimate that, through implementation of Healthy California, overall costs of providing full health care coverage to all Californians could fall by about 18 percent relative to spending levels under the existing system," the authors of the report note.

They conclude:

In sum, the establishment of the Healthy California single-payer system will generate financial benefits for both families and businesses throughout the California economy. For families at most income levels and for businesses of most sizes, these financial benefits will be substantial. These benefits are in addition to those that the residents of California will achieve through having universal access to decent health care.

The analysis, which was commissioned by the California Nurses Association/National Nurses Association, adds fuel to an ongoing debate over the costs of insuring all Californians—a debate sure to reverberate nationally.

As the extremely unpopular American Health Care Act lingers in the Senate, polls increasingly show that most Americans view single-payer healthcare favorably. Last year, Gallup found that a majority of Americans would support replacing the Affordable Care Act with a Medicare-for-all style program. PERI's analysis attempts to show that such a program, if implemented correctly, is no utopian fantasy but rather fiscally sound public policy.

"What this new study proves is that we can finally achieve the dream of guaranteeing health care for all Californians, without the punishment of crippling out of pocket costs, at far less than what was predicted by those who make enormous profits off the pain and suffering of everyday Californians," said RoseAnn DeMoro, the executive director of National Nurses United.

According to a new survey published by Tulchin Research firm, Californians are strongly behind each of these objectives.

94 percent of respondents favor lower healthcare costs

82 percent "favor eliminating premiums, co-pays, deductibles, and all out of pocket expenses for covered services"

81 percent "support ensuring every Californian has healthcare"

"70 percent of Californians favor establishing a public, Medicare for all type system"

Previous reporting suggested, contrary to PERI's findings, that the Healthy California Act would impose exorbitant and unsustainable costs on the state.

"Democrats' single-payer health-care dream just became a nightmare," CNBC ominously declared following the publication of a study conducted by the California State Senate, which found that the Healthy California Act would cost $400 billion annually.

Many, however, have questioned the extent to which the panic-stricken tones of major headlines align with the numbers. Matt Bruenig, writing for Jacobin, pointed out that, if the State Senate numbers are correct, California would ultimately spend "15 percent of the state's GDP" on healthcare—"three percentage points lower than the share of GDP the United States overall spends."

In conclusion, Bruenig noted that "if the plan would work like this report says it does and at the cost this report says it does, it is a no-brainer."

Some commentators have attempted to bolster the economic case for single-payer with a moral argument, as Sarah Jones did recently in The New Republic.

"It's a matter of policy, yes, but of morality too, and there is an unassailable moral logic for single-payer," Jones argued. "Opponents of single-payer must reckon with it, just as they ask advocates to reckon with political practicalities. Advocates must repeatedly ask: Is the status quo tolerable?"

Increasingly, judging by surveys of public opinion and town-hall confrontations, Americans are answering Jones's question with a resounding 'no.' In California, the goal for single-payer backers now is turning popular sentiment into political reality.

"Healthcare costs Californians billions and one-third of people with healthcare still don't have enough coverage," said California State Senator Ricardo Lara in a statement. "The good news is that California can get a lot more for our money and reduce the costs of healthcare for middle class families and businesses."

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May 12, 2017

Participation in the compulsory Dutch Basic health care plan is required by ALL residents. There is also optional additional health care insurance offered in the form of “upgrades.”Basic planpremium/deductible costs and benefit coverage are IDENTICAL for EVERYONE – regardless of age, health condition, location, background or income (except that premiums arereduced by ‘allowances” given to low-income people.

The annual premium is EUR 1,440 ( $1,585) for anyone 18 years or older or EUR 2,880 ($3,170) for 2 people with children under 18. Children up to 18 are co-insured with their parents; children under 18 must take out the Basic plan insurance. The individual deductible is EUR 385 ($425). But GP consultations, maternity care, medical devices, home care, and management of some chronic conditions are excluded from the deductible policy. By comparison the US Medicare premium is $1608. per year. If you're lucky enough to have an employer sponsored plan, the average premium cost per year is $4955. for a family.

For a family of 4, the Basic health plan cost is EUR 3,650 ($4,015) for premiums and deductibles, +-EUR 1,200 ($1,320) for dental for 2 adults and 2 children below 18. If a family of 4 purchased all the medical items in the upgrade groupings – which is highly UNLIKELY by most Dutch people – the added premium cost would be +-EUR 2,880 ($3,160) for 2 adults leading to a grand total cost of EUR 6,530 ($7,185). Most studies show that a U.S. family of 4 pays over $16,000 annually for health care insurance that does not have the comprehensive coverage the Dutch Basic plan has for EVERYONE.

The Basic health plan funding comes 50% from employers, 45% from the insured, and 5% from the government. Employers pay a % of their employee’s income amounting to 7.65% to the Tax Administration. The self-employed and pensioners pay an average of 5.4% of their income. This money goes into the Health Insurance Fund and is distributed to insurers for the purpose of “risk equalization.” All these figures are hardly a picture of runaway government health care spending in the Netherlands!

A married couple, or a person with a fiscal partner, with a combined annual income below EUR 28,000 ($31,000) is entitled to a health insurance “allowance.” Depending on income level, the “allowance” can cover up to 70% of the annual EUR 2,880 ($3,170) premium cost for 2 people. Health insurers receive nominal premiums (that vary less than 8% among the competing insurers) plus “risk adjusted contributions” from the Health Insurance Fund. An insurer receives a higher or lower contribution from the Fund depending on the health of its customers/policyholders.

The identical coding of medical treatments, products, and services throughout the system and country yields significant cost economies and improvements by comparing performances of service providers. So the cost of an appendix operation in the Netherlands will be pretty much the SAME anywhere in the country - unlike the U.S. where the cost of the SAME medical service varies sharply WIDELY within each state as well as among states.

The Way a Health Care "Market" Should Work

“Managed competition” is unique foundation basis of the Dutch Basic health care system. It means that consumers can choose from a market of health care insurers that compete predominantly on quality of services as well as operating efficiency. About 90% of all Dutch policyholders (+15 million people) are insured by 5 insurers (of which 3 are non-profit firms). Thus, there are around 3 million policyholders per insurer. This policyholder depth and broad variation combined with an identical Basic comprehensive benefits package for everyone - regardless of age, health condition, location, background, and income - results in a very well-balanced actuarial risk pool per insurer. Also, the development of a uniform treatment policy and excellent transparency of same facilitates competition, the comparison and critical assessment of worst and best practices by health providers.

Insurers are regulated by the government that has prime oversight responsibility. The government's role is not about directly managing the health care system but controlling its quality, accessibility, and affordability (costs and prices). It is in charge of the contents and size of the Basic health plan insurance package. The government is advised on these issues by the National Health Institute, an independent authority that has a major responsibility for the Basic plan package. An“insuranceregulator” ensures that all Basic health plans have identical coverage so that NO ONE is disadvantaged by the choice of insurer. Insurers are not allowed to “risk-select” people for the universal Basic health plan package.

Based on advice from the National Health Institute, the government decides on which types of care are included in the Basic plan insurance package. At year-end, a new Basic health plan package is approved for coming year whereby benefits coverage, premiums and deductibles are IDENTICAL for ALL - whether one is a millionaire, a billionaire, or poor. Once a year, a person can change his or her health insurance provider for another, for the following year.

The Basic health plan package has a comprehensive structure. It covers the bulk of essential medical care services, medications, and medical aids, consistent with the state-of-the-art and medical practice. Here is a list medical services and treatments covered:

delivery and maternity care, full coverage of a home delivery and mid-wife services which are common ; a hospital delivery recommended by a GP or specialist requires a contribution to the costs which insurers offer additional insurance for

medications, medicine prescriptions

medical aids

dental care up to 18

basic mental health services including hospital care (mental health related) up to maximum of three years

Supplementary Insurance Covers Things Not Usually Covered by US Insurance Plans

On top of the statutory Basic health plan insurance for ALL, individuals can purchase supplementary insurance for medical care items that are not or only partly covered under the Basic health plan package. The supplementary insurance is offered by insurers in some form of 3 or 4-star “upgrade” groupings. Most people purchase some supplementary private health insurance from the same insurers who provide the statutory coverage. However, the supplementary insurance is voluntary; insurers are free to “risk-select” and even to refuse to insure certain people. Typical supplementary medical coverage items in the various “upgrade” groupings include:

To put the premium cost of supplementary upgrades in some perspective, if an individual purchased insurance coverage of ALL medical items in each upgrade grouping from an insurer – a highly unlikely event - the maximum added annual premium cost would be around EUR 1,440 ($1,585). This is the same cost as the Basic health plan premium cost for an individual. Most Dutch policyholders purchase some supplementary private health insurance along with the compulsory Basic health plan insurance.

Under the Exceptional Medical Expenses Act, a national government insurance scheme called AWBZ provides exceptional long-term medical care for the elderly, disabled, or the chronically ill. AMBZ insures a person against risks not covered by the Basic health plan insurance or supplementary insurance upgrades. AMBZ covers steep medical expenses simply not affordable such as long-term home care, or admittance to a nursing home or a home for the disabled. Everyone who resides in the Netherlands has a right to this coverage.

SUMMARY

Of course there are management problem-glitches and challenges here and there - especially emanating from the sharply rising elderly group and their considerable medical care needs over the coming years. This group is quite vulnerable to extensive and costly illnesses. The total cost of healthcare in the Netherlands is 11.5% of GDP versus 16.5% in the U.S.

For the Dutch, the task is formidable to keep it at that level in light of a growing aging society living longer, increasingly expensive technology, and drugs. That is why preventive care actions constantly promoting people to adopt healthy lifestyles of controlled stress, healthy diet and exercise regimens have long been of high priority in the Dutch health care system.

So far, the Dutch “Managed Competition” approach to health care is proving to be one of the best systems worldwide. Recently, the Legatum Institute, a highly reputable London-based research institute, ranked the Netherlands as having the world's 5th best health care system compared to U.S. ranking of 32. (see: “The 16 Countries With the World's Best Health Care Systems,” The Legatum Prosperity Index-2016, by Will Martin, Jan. 13, 2017).

Frank Thomas, The Netherlands, May 10, 2017

FOOTNOTE: Comparing Dutch Health Care System to U.S. System

I will follow above up with a short summary of how and why Obamacare has failed and why Trumpcare is also destined to fail. I will compare both to the Dutch health care system.

The U.S. has still not learned that it's financially impossible to have a sound, relatively simple, quality health care system for ALL when it is driven by age, health, income, location variations and a non-uniform medical coding and costing system that lacks transparency and uniformity within most states and among states. Practically every medical treatment and medication an individual undergoes in the states is about 2 to 8 times more costly than the same treatment in the Netherlands (and 3 times the same treatment in Canada). I will cover the key reasons WHY this is so.

We learn NOTHING from the more effective foreign health care systems that provide better and broader quality coverage for more than half the cost to an insured individual than occur in most of the states. Political ideological indoctrination is also a big contributor to the MESS we are in with our extremely costly health care system - namely the Republican pure conservative dogma of the anti-government social benefit tribe that the well-off should not be paying for the not-so-well-off.

This compares to an entirely different core value construct deeply enshrined in Europe where people in the main fundamentally believe "We are all in this life together," especially when it comes to such basic needs as quality healthcare for all. It's not so surprising that that simple pervasive core value and thinking leads to much lower cost and higher quality universal health care systems in Europe.

May 07, 2017

Shame on every one of the 217 Republicans who voted to repeal the Affordable Care Act on Thursday, and substitute basically nothing.

Trumpcare isn’t a replacement of the Affordable Care Act. It’s a transfer from the sick and poor to the rich and healthy.

The losers are up to 24 million Americans who under the Affordable Care Act get subsidies to afford health insurance coverage, including millions of people with pre-existing conditions and poor people who had access to Medicaid who may not be able to afford insurance in the future.

The winners are wealthy Americans who will now get a tax cut because they won’t have to pay to fund the Affordable Care Act, and healthy people who won’t have to buy health insurance to subsidize the sick.

House Republicans say they have protected people with pre-existing health problems. Baloney. Sick people could be charged premiums so high as to make insurance unaffordable. Trumpcare would even let states waive the Obamacare ban on charging higher premiums for women who have been raped — which actually occurred before the Affordable Care Act.

America has the only healthcare system in the world designed to avoid sick people. Private for-profit health insurers do whatever they can to insure groups of healthy people, because that’s where the profits are. They also make every effort to avoid sick people, because that’s where the costs are.

The Affordable Care Act puts healthy and sick people into the same insurance pool. But under the Republican bill that passed the House, healthy people will no longer be subsidizing sick people. Healthy people will be in their own insurance pool. Sick people will be grouped with other sick people in their own high-risk pool – which will result in such high premiums, co-payments, and deductibles that many if not most won’t be able to afford.

Republicans say their bill creates a pool of money that will pay insurance companies to cover the higher costs of insuring sick people. Wrong. Insurers will take the money and still charge sick people much higher premiums. Or avoid sick people altogether.

The only better alternative to the Affordable Care Act is a single-payer system, such as Medicare for all, which would put all Americans into the same giant insurance pool. Not only would this be fairer, but it would also be far more efficient, because money wouldn’t be spent marketing and advertising to attract healthy people and avoid sick people.

Paul Ryan says the House vote was about fulfilling a promise the GOP made to American voters. But those voters have been lied to from the start about the Affordable Care Act. For years Republicans told them that the Act couldn’t work, would bankrupt America, and result in millions losing the healthcare they had before. All of these lies have been proven wrong.

Now Republicans say the Act is unsustainable because premiums are rising and insurers are pulling out. Wrong again. Whatever is wrong with the Affordable Care Act could be easily fixed, but Republicans have refused to do the fixing. Insurers have been pulling out because of the uncertainty Republicans have created.

The reason Republicans are so intent on repealing the Affordable Care Act is they want to give a giant tax cut to the rich who’d no longer have to pay the tab.

Here we come to the heart of the matter.

If patriotism means anything, it means sacrificing for the common good, participating in the public good. Childless Americans pay taxes for schools so children are educated. Americans who live close to their work pay taxes for roads and bridges so those who live farther away can get to work. Americans with secure jobs pay into unemployment insurance so those who lose their jobs have some income until they find another.

And under the Affordable Care Act, healthier and wealthier Americans pay a bit more so sicker and poorer Americans don’t die.

Trump and House Republicans aren’t patriots. They don’t believe in sacrificing for the common good. They don’t think we’re citizens with obligations to one another. To them, we’re just individual consumers who deserve the best deal we can get for ourselves. It’s all about the art of the deal.

So what do we do now? We fight.

To become law, Trumpcare has to go through 4 additional steps: First, a version must be enacted in the Senate. It must then go a “conference“ to hammer out differences between the House and Senate. The conference agreement must then pass in the House again, and again in the Senate.

I hope you’ll be there every step of the way, until Trumpcare collapses under the weight of its own cruelty. House Republicans who voted for this travesty will rue the day they did. Any Senate Republican who joins them will regret it as well.

March 18, 2017

The new American Health Care Act has been unveiled, and critics are calling it more flawed even than the Obamacare it was meant to replace. Dubbed “Ryancare” or “Trumpcare” (over the objection of White House staff), the Republican health care bill is under attack from left and right, with even conservative leaders calling it “Obamacare Lite”, “bad policy”, a “warmed-over substitute,” and “dead on arrival.”

The problem for both administrations is that they have been trying to fund a bloated, inefficient, and overpriced medical system with scarce taxpayer funds, without capping its costs. US healthcare costs in 2016 averaged $10,345 per person, for a total of $3.35 trillion dollars, a full 18 percent of the entire economy, twice as much as in other industrialized countries.

Ross Perot, who ran for president in 1992, had the right idea: he said all we have to do is to look at other countries that have better health care at lower cost and copy them.

So which industrialized countries do it better than the US? The answer is, all of them. They all not only provide healthcare for the entire population at about half the cost, but they get better health outcomes than in the US. Their citizens have longer lifespans, fewer infant mortalities and less chronic disease.

President Trump, who is all about getting the most bang for the buck, should love that.

Hard to Argue with Success

The secret to the success of these more efficient systems is that they control medical costs. According to T. R. Reid in The Healing of America, they follow one of three models: the “Bismarck model” established in Germany, in which health providers and insurers are private but insurers are not allowed to make a profit; the “Beveridge model” adopted in Britain, where most healthcare providers work as government employees and the government acts as the single payer for all health services; and the Canadian model, a single-payer system in which the healthcare providers are mostly private.

A single government payer can negotiate much lower drug prices – about half what we pay in the US – and lower hospital prices. Single-payer is also much easier to administer. Cutting out the paperwork can save 30 percent on the cost of insurance. According to a May 2016 post by Physicians for a National Health Program:

"Per capita, the U.S. spends three times as much for health care as the U.K., whose taxpayer-funded National Health Service provides health care to citizens without additional charges or co-pays. In 2013, U.S. taxpayers footed the bill for 64.3 percent of U.S. health care — about $1.9 trillion. Yet in the U.S. nearly 30 million of our citizens still lack any form of insurance coverage.The for-profit U.S. health care system is corrupt, dysfunctional and deadly. In Canada, only 1.5 percent of health care costs are devoted to administration of its single-payer system. In the U.S., 31 percent of health care expenditures flow to the private insurance industry. Americans pay far more for prescription drugs. Last year, CNN reported, Americans paid nearly 10 times as much for prescription Nexium as it cost in the Netherlands."

Single payer, or Medicare for All, is the system proposed in 2016 by Democratic candidate Bernie Sanders. It is also the system endorsed by Donald Trump in his book The America We Deserve. Mr. Trump confirmed his admiration for that approach in January 2015, when he said on David Letterman:

"A friend of mine was in Scotland recently. He got very, very sick. They took him by ambulance and he was there for four days. He was really in trouble, and they released him and he said, ‘Where do I pay?’ And they said, ‘There’s no charge.’ Not only that, he said it was like great doctors, great care. I mean we could have a great system in this country."

Contrary to the claims of its opponents, the single-payer plan of Bernie Sanders would not have been unaffordable. Rather, according to research by University of Massachusetts Amherst Professor Gerald Friedman, it would have generated substantial savings for the government:

"Under the single-payer system envisioned by “The Expanded & Improved Medicare For All Act” (H.R. 676), the U.S. could save $592 billion – $476 billion by eliminating administrative waste associated with the private insurance industry and $116 billion by reducing drug prices…."

According to OECD health data, in 2013 the British were getting their healthcare for $3,364 per capita annually; the Germans for $4,920; the French for $4,361; and the Japanese for $3,713. The tab for Americans was $9,086, at least double the others. With single-payer at the OECD average of $3,661 and a population of 322 million, we should be able to cover all our healthcare for under $1.2 trillion annually – well under half what we are paying now.

The Problem Is Not Just the High Cost of Insurance

That is true in theory; but governments at all levels in the US already spend $1.6 trillion for healthcare, which goes mainly to Medicare and Medicaid and covers only 17 percent of the population. Where is the discrepancy?

For one thing, Medicare and Medicaid are more expensive than they need to be, because the US government has been prevented from negotiating drug and hospital costs. In January, a bill put forth by Sen. Sanders to allow the importation of cheaper prescription drugs from Canada was voted down. Sanders is now planning to introduce a bill to allow Medicare to negotiate drug prices, for which he is hoping for the support of the president. Trump indicated throughout his presidential campaign that he would support negotiating drug prices; and in January, he said that the pharmaceutical industry is “getting away with murder” because of what it charges the government. As observed by Ronnie Cummins, International Director of the Organic Consumers Association, in February 2017:

"[B]ig pharmaceutical companies, for-profit hospitals and health insurers are allowed to jack up their profit margins at will….Simply giving everyone access to Big Pharma’s overpriced drugs, and corporate hospitals’ profit-at-any-cost tests and treatment, will result in little more than soaring healthcare costs, with uninsured and insured alike remaining sick or becoming even sicker."

Besides the unnecessarily high cost of drugs, the US medical system is prone to over-diagnosing and over-treating. The Congressional Budget Office says that up to 30 percent of the health care in the US is unnecessary. We use more medical technology than in other countries, including more expensive diagnostic equipment. The equipment must be used in order to recoup its costs. Unnecessary testing and treatment can create new health problems, requiring yet more treatment, further driving up medical bills.

Drug companies are driven by profit, and their market is sickness – a market they have little incentive to shrink. There is not much profit to be extracted from quick, effective cures. The money is in the drugs that have to be taken for 30 years, killing us slowly. And they are killing us. Pharmaceutical drugs taken as prescribed are the fourth leading cause of US deaths, according to a Harvard study.

The US is the only industrialized country besides New Zealand that allows drug companies to advertise pharmaceuticals. Big Pharma spends more on lobbying than any other US industry, and it spends more than $5 billion a year on advertising. Lured by drug advertising, Americans are popping pills they don’t need, with side effects that are creating problems where none existed before. Americans compose only 5 percent of the world’s population, yet we consume 80 percent of the world’s pain pills. We not only take more drugs (measured in grams of active ingredient) than people in most other countries, but we have the highest use of new prescription drugs, which have a 1 in 5 chance of causing serious adverse reactions after they have been approved.

The US death toll from prescription drugs taken as prescribed is now 128,000 per year. As Jon Rappaport observes, with those results Big Pharma should be under criminal investigation. But the legal drug industry has grown too powerful for that. According to Dr. Marcia Angell, former editor in chief of the New England Journal of Medicine, writing in 2002:

"The combined profits for the ten drug companies in the Fortune 500 ($35.9 billion) were more than the profits for all the other 490 businesses put together ($33.7 billion). Over the past two decades the pharmaceutical industry has [become] a marketing machine to sell drugs of dubious benefit, [using] its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself."

It’s Just Good Business

US healthcare costs are projected to grow at 6 percent a year over the next decade. The result could be to bankrupt not only millions of consumers but the entire federal government.Obamacare has not worked, and Ryancare is not likely to work. As demonstrated in many other industrialized countries, single-payer delivers better health care at half the cost that Americans are paying now.

Winston Churchill is said to have quipped, “You can always count on the Americans to do the right thing after they have tried everything else.” We need to try a thrifty version of Medicare for all, with negotiated prices for drugs, hospitals and diagnostic equipment.

Ellen Brown is the founder of the Public Banking Institute and a Research Fellow at the Democracy Collaborative. She is the author of a dozen books including the best-selling Web of Debt, on how the power to create money was usurped by a private banking cartel; and The Public Bank Solution, on how the people can reclaim that power through a network of publicly-owned banks. She has written over 300 articles, posted at EllenBrown.com; and co-hosts a radio program on PRN.FM called “It’s Our Money with Ellen Brown.”

January 25, 2017

Republicans were fine with the way it was for the health care system before Obamacare went into effect. So why not just go back to the good old days when a pre-existing condition was enough to let an insurance company reject you from coverage? The good old days when price gouging by insurance companies was the order of the day. The good old days when pharmaceutical corporations could charge whatever they want for life saving drugs. Oh, that part is still true under Obamacare.

The "Repeal and Replace" mantra was always nothing more than a slogan. Republicans have had 8 years to suggest a different system or enhancements to the one currently in effect. The sticking point is the pre-existing conditions part of Obamacare. According to a Kaiser Family Foundation Health Tracking Poll, 49 percent of respondents said they or a family member have a pre-existing condition. So eliminating that provision of Obamacare will affect a lot of Americans and Trump voters in particular. But Republicans will probably bite the bullet and do it anyway.

First of all Obamacare expanded Medicaid which is health care coverage for poor people. Well, poor people are not the Republicans' traditional constituency. Rich people are, and rich people don't have any problem with their health insurance coverage even if they have to pay through the nose for it. It's a minor part of their expenses. Obamacare also gave subsidies to many people to get health insurance coverage. Well, people needing subsidies are not rich. The rich don't need subsidies from the government. So Republicans don't mind canceling this provision also. That leaves people who don't need financial support or subsidies to provide health insurance for themselves. That means rich or better off Republicans.

Republicans don't care that 20 million people have health insurance due to Obamacare that didn't have it before because that's 20 million poor or lower middle class people, people that vote for Democrats. Republicans would be happy to see all those people lose their health insurance as they subject them to the free market. After all they're great believers in the free market. If you can't afford to pay, you go without, and that's what Republicans believe in. Whether it's food, shelter, education or health insurance, Republicans don't care if those that can't afford to pay go without.

What About Emergency Room Care for Those Who Can't Pay?

So that means that poor people will have to rely on going to the emergency room every time they have a health problem? Don't count on that either. It's simply a law that emergency rooms have to take in people who can't pay and provide some treatment at public expense. That law can be repealed by a Republican Congress just as easily as they can repeal Obamacare. That means that poor people will not be able to access emergency rooms either. They will have to rely on charity as a last resort. Republicans do believe in charity. After all isn't that the American way? Rich people helping poor people instead of the government helping them? Noblesse oblige.

Pretty much charitable institutions are dependent on private philanthropy to keep them afloat. You are increasingly besieged by charitable institutions asking you to support them. Even at the check-out counter. Every time you buy pet food, you are asked by Petco to donate to help a homeless animal. Of course, you are not asked to contribute to homeless humans. They can fend for themselves and pull themselves up by their own bootstraps, those lucky enough to have boots, that is.

Even though Trump hasn't come up with a replacement plan, House speaker Paul Ryan has several ideas. One is that, even if you lose your job at which your employer was paying for health insurance, you would still be allowed to pay for it yourself and not lose coverage. Of course, if you lose your job, you could ill afford to pay out of your pocket for health insurance. But that gets back to the Republican principle if you can't pay for something you should do without. And if you miss one payment, that is enough for your health insurance provider to cancel your policy.

Another Republican mantra for replacing Obamacare is to allow health insurance companies to sell insurance across state lines. The idea is that by eliminating the red tape associated with state insurance regulation, insurers will be able to offer national plans with lower administrative costs. Oh, how the Republicans love to deregulate. There would be fewer rules imposed by the states, and insurers would only have to comply with minimal Federal regulations. I emphasize the word minimal. Supposedly this would increase competition among health insurance companies, and Republicans are always in favor of more competition, that is, unless the various corporations merge. Mergers and acquisitions are something Repubs like even more than competition.

Pre-existing Condition? No Problem

Back in the good old days, people with pre-exisitng conditions were covered by what was known as "risk pools." It has been reported:

For sick patients who cannot continue coverage, Ryan’s plan calls for a return to state-run high-risk pools. These pools allow sick people to buy insurance separately, while states, insurers and the federal government help subsidize the cost. The president-elect’s website says he supports risk pools.

Risk pools have a long and controversial past. Before the ACA was passed, 35 states ran risk pools for people with preexisting conditions ranging from cancer and diabetes to more minor afflictions such as arthritis or eczema. Premiums for risk pool coverage were as much as 250 percent more than a healthy person would pay for individual insurance, and some states, overwhelmed with sick patients, had wait lists for coverage or imposed other restrictions, said [Cheryl] Fish-Parcham [Private Insurance Program Director, Families USA].

“Going back to risk pools is going back to the bad old days,” she said.

“High-risk pools served only 1 percent of the population back in 2008,” said Fish-Parcham. That wasn’t anywhere near the number of people who needed coverage but couldn’t afford it, she noted, adding: “Risk pools simply didn’t work.”

Another way insurance companies get out of paying a lot of money is life time caps. Republicans would be happy to see that as part of the "replacement." So if you have a serious chronic condition, you will be treated up until the time when you reach your life time cap. After that you're shit out of luck. Your benefits will have run out. It's back to the risk pool for you. Or you can throw yourself on charity. Maybe have someone open a Go-Fund-Me website for you. Or you might win with Publisher's Clearing House. Most people though will just have to grin and bear it. And eventually they will die. That's the ultimate denouement.

Republicans are supportive of the rich, the talented and those who can make it on their own. They don't have much sympathy for poor people, especially poor and sick people. The poor and the sick, the lame and the halt, don't deserve to be a part of country club earth. Republicans consider themselves to be the "best and the brightest." They are the ones who need to be supported and encouraged, whose genes need to be transfered to the next generation. They are all about the improvement of the race.

March 04, 2016

You can blame lobbyists from the health insurance and pharmaceutical industry in conjunction with Republican lawmakers who lobbied the Affordable Care Act to death making it in the long run unaffordable and probably untenable. Why? Because there are no cost containment features in the Act. None. Nada. Zippo.

What that means is that the drug companies can raise the prices of drugs 5000% like Martin Shkreli of Turing Pharmaceuticals did for Daraprim without breaking the law. Shkreli's arrogance, the latest example of which is calling the Congressmen who interrogated him "imbeciles", has gotten him into much trouble but not for raising the price of a life saving drug 5000%.

You see in America, my friends, screwing unfortunates with heart disease and cancer is not a crime but defrauding investors out of their money is. Your Republican controlled government is not looking out for the little guy. Lobbyists are running the lawmakers. Oh, you don't have a lobbyist working for you? Then you're shit out of luck. With the exception of a few good Democrats like Elizabeth Warren and Bernie Sanders, your interests are not only being ignored. You're being considered as sheep to be led to slaughter.

Republican gerrymandering, voter suppression and the filibuster have guaranteed that only Republican laws will be put into effect, and that means that corporations have the right to screw you but the investor class will be protected. In fact after the 2008 Wall Street caused financial meltdown, investors were paid back 100 cents on the dollar (there were no haircuts), and the only rule applying to the little guy was that he had to pay his debts 100 cents on the dollar (there were no write downs for underwater mortgages).

But I digress. The company leading the pack in drug price increases is Canada-based Valeant, which lifted list prices by at least 20% some 122 times since the beginning of 2011. Isuprel and Nitropress, the heart drugs Valeant bought from another company, have been staples of medical care for decades. Doctors use Isuprel during procedures treating heart-rhythm problems, and give Nitropress to emergency patients whose blood pressure has risen to life-threatening levels. Doctors say there are few good alternatives.

Valeant Pharmaceuticals Pondered Carefully How Much It Could Charge for a Lifesaving Drug

Valeant Pharmaceuticals has also been in the business of making life-saving drugs for heart disease, AIDS and cancer unaffordable. Evidence has been brought to light that Valeant Pharmaceuticals carefully pondered how much it could raise the price of heart drugs Isuprel and Nitropress before buying them and then raised the prices overnight by 525% and 212% respectively.

Profit was the only consideration. Blame the lobbyists who cut cost containment out of Obamacare, not Obama. “Our duty is to our shareholders and to maximize the value” of the products that Valeant sells, said Laurie Little, a company spokeswoman.

Ascension health system, which operates 131 hospitals across the country, estimates the increases will triple its spending on the drugs this year to $8 million. Ever wonder why health care premiums are so high? Richard Fogel, a heart doctor at Ascension’s St. Vincent Heart Center in Indianapolis, said the lack of good alternatives in certain clinical situations leaves him little choice but to keep using the pair.

Cleveland Clinic says the price hikes for the two Valeant drugs is unexpectedly adding $8.6 million, or 7%, to this year’s budget of roughly $122 million for medicines administered at its hospitals. Like its peers, Cleveland Clinic generally pays for drugs it administers, then hopes the reimbursement it receives for patient care will cover the expense.

Companies are buying established drugs from other companies and then jacking up the prices. Early last year, Mallinckrodt PLC paid $1.4 billion for Cadence Pharmaceuticals, though the Ofirmev pain injections that were the crown jewel of the deal were projected to have just $110.5 million in revenue for 2013, according to a Mallinckrodt conference call with analysts discussing the deal. However, Mallinckrodt had a better idea with regard to pricing.

Three months later, the list price for a package of 24 Ofirmev vials jumped almost 2½ times to $1,019.52. “It seemed like highway robbery,” said Erin Fox, who directs the drug information service at University of Utah Health Care.

These price increases can be very lucrative; that, not patient care, is the whole idea. Horizon Pharma PLC upped the price of Vimovo pain tablets after buying the rights from AstraZeneca in late 2013. On Jan. 1, 2014, its first day selling Vimovo, Horizon raised the list price for 60 tablets to $959.04, a 597% increase. Horizon raised the price again on Jan. 1 this year to $1,678.32 for the tablets.

Prices were hiked dramatically on a drug used for "swimmer's ear" - Cortisporin-TC Otic Suspension. Cortisporin was originally developed by Glaxon Wellcome and approved by the Food and Drug Administration (FDA) in 1975. Glaxo sold the rights to the drug to Monarch Pharmaceuticals in 1997. Ten years later it was sold to JHP Pharmaceuticals which was acquired by Par Pharmaceuticals in 2014 which was acquired by Endo International for $8 billion.

A vial used to cost $6.A few years ago Cortosporin was selling for $10. Last year it went for $100. and now it's $200. This is a product that helps kids recover from ear infections. Heather Lubeski, Endo's senior director of corporate affairs, said the company is "committed to providing top quality products to patients to improve lives." She believes the product's pricing is "rational and appropriate."

After Price Gouging the Public, Drug Companies Move to Ireland to Avoid Paying US Taxes

Endo moved to Ireland to avoid paying millions of dollars in US business taxes. Endo’s moving to Ireland is part of one of the biggest trends in global mergers and acquisitions. It's called tax inversion. By moving their headquarters to another country, US companies are able to slash taxes.

Now Pfizer, maker of Viagra and Celebrex, wants to pull the same crap: first price gouge, then move to Ireland to avoid US taxes.Pfizer intends to save $35 billion in taxes by merging with Allergan. A group called Americans for Tax Fairness (ATF) is urging the US government to block the merger which would let Pfizer do a "tax inversion" but keep its offices in New York City where they are now. The group also accuses Pfizer of gouging Americans with frequent and excessive price hikes while benefiting from multiple loopholes and deductions which effectively reduce its global tax rate to 6.4%.

"This is theft, what Pfizer is doing," said Frank Clemente of ATF. "This is a company that is extremely profitable. It's ripping us off in two ways. It's dodging taxes and jacking up prices."

Pfizer has raised prices on multiple drugs including Viagra, Celebrex, Lyrica and Zyvox by over 39% from 2013 to 2015 - 23 times the rate of inflation! This year it's already raised prices on 60 drugs by more than 10%. Like Shkreli of Turing Pharmaceuticals, Pfizer is pleasing its Wall Street overlords and masters by squeezing as much profit as possible out of its products. That's their only consideration.

Shkreli gloated to investors about all the money he and they were going to make on Daraprim while any compassion for the unfortunate people, for whom Daraprim was a life-saving drug, went totally out the window. Here's what he told his investors: "So 5000 paying bottles at the new price is $375,000,000 - almost all of it is profit, and I think we will get three years of that or more. Should be a very handsome investment for all of us. Let's all cross our fingers that the estimates are accurate." The unmitigated greed is appalling. Some patients were left with co-pays of $16,000!

Credit Democrat Elijah Cummings for using his position as head of the House Committee on Oversight and Government Reform to bring thousands of pages of documents to light that made it clear that Valeant's and Turing's only concerns were how much profit they could make by buying drugs and raising their prices exorbitantly.

Before buying Isuprel and Nitropress, Valeant hired a consultant to determine by how much the prices for the two drugs could be raised. It was determined that there was "ample room" to price gouge unfortunates because previous large increases had not "dampened use." Lambs being led to slaughter? You bet.

Imagine the Powerpoint presentation as the pricing consultant presented to Valeant executives the information that the goal for 2015 was for $279.3 million in revenue for Isuprel up from $54.5 million in 2014. Similarly, the goal for Nitropress was $245.5 million up from $98.7 million in 2014. The executives probably were immensely satisfied as they high fived each other over "aggressive pricing through consultant recommendation." That quote was actually taken from one of the documents that Cummings was able to obtain.

The Truth About the Drug Companies

Way back in 2004 Dr. Marcia Angell published a book, The Truth About the Drug Companies - How they Deceive Us and What to Do About It. During her two decades at TheNew England Journal of Medicine, Dr. Marcia Angell had a front-row seat on the appalling spectacle of the pharmaceutical industry. She watched drug companies stray from their original mission of discovering and manufacturing useful drugs and instead become vast marketing machines with unprecedented control over their own fortunes.

Instead of doing research like they say they need their vast profits for, they lobby Congress, produce drugs of dubious value and pay their executives obscene sums. They use TV advertising to convince the American people they need their drugs - even those that will ultimately cause them harm. They pay competitors not to produce cheap generic drugs. They pay doctors to prescribe their drugs.

It's all about the free enterprise system, folks, conceived and dedicated to keeping Americans free to charge you outrageous prices especially if your life depends on their products. They have no mercy whatsoever or concern for their fellow human beings. It's all about making as much money as possible. As one of the 1% class said, "You only have to make a fortune once." Short term profits are what it's all about, folks.

By Angell's account, the current slide toward the commercialization and corruption of clinical research coincided with the election of President Ronald Reagan in 1980 and the passage of the Bayh–Dole Act, a new set of laws that permitted and encouraged universities and small businesses to patent discoveries from research sponsored by the National Institutes of Health (NIH). Research paid for by the public to serve the public instantly became a private, and salable, good, one that is producing drug sales of more than $200 billion a year. ...

The same companies also spend heavily to lobby governments. According to Angell, Pharmaceutical Research and Manufacturers of America, the pharmaceutical industry's U.S. trade association, has “the largest lobby in Washington,” which in 2002 employed 675 lobbyists (including 26 former members of Congress) at a cost of more than $91 million. [In 2014 the pharmaceutical industry spent $229 million lobbying.] The result has been above-average growth in corporate profits during both Republican and Democratic administrations.

The most recent and (at least to observers outside the United States) perplexing lobbying effort caused Congress explicitly to prohibit Medicare from using its huge purchasing power to get lower prices for drugs, thus opening up a dollar pipeline, in the form of higher drug prices, directly from taxpayers to corporate coffers. These changes, along with the cave-in by the Food and Drug Administration (FDA) in 1997 that permitted direct-to-consumer advertising to bypass mention in their ads of all but the most serious side effects, have further augmented profits. The overall effect has been a corruption not only of science but also of the dissemination of science.

That was in 2004. It's even worse today. The bottom line is that the American public is being screwed by Big Pharma in conjunction with Republican lawmakers. It's not Obama's fault. He did the best he could. Unfortunately, Obamacare is flawed not due to Obama but due to the fact that he had to make concessions to lobbyists for the pharmaceutical industry to get the ACA legislation passed at all. Bernie Sanders wants to take it to the next level - Medicare for all. Just the elimination of all the paperwork involved in today's medical industry will save billions of dollars as will the proscription of the legislative provisions which disallow Medicare from negotiating drug prices.

Big Pharma Raised Prices Again in January

Drugmakers didn’t let up on price increases with the start of the new year, demonstrating the industry’s pricing power in the face of mounting criticisms of prescription costs in the U.S. Pfizer, Amgen,Allergan, Horizon Pharma and others have raised U.S. prices for dozens of branded drugs as of January 2016, with many of the increases between 9% and 10%. Some of the increases add thousands of dollars to the cost of already expensive drugs, and come on top of repeated price hikes in recent years.

Vanda Pharmaceuticals on Jan 1 raised the price of its new drug Hetlioz, which treats a sleep disorder in blind people, by 10%, to $148,000 a year, a spokeswoman said. Piper Jaffray analysts say the price of the once-daily capsule is now 76% higher than when it was introduced in 2014.

Since New Year’s Day, Pfizer has raised list prices an average of 10.6% for more than 60 branded products with annual U.S. sales of at least $10 million, according to Deutsche Bank. Prices for eight of the products went up at least 20%.

Amgen raised the price of the anti-inflammatory drug Enbrel by 8% in late December following an 8% increase in September and a 10% increase last May. Enbrel costs about $704 a week for the typical dosing for treatment of rheumatoid arthritis or more than $36,600 a year.

Acorda Therapeutics raised the price of its drug Ampyra, which is used to help multiple-sclerosis patients improve walking, by 11% on Jan. 1, to an annual cost of more than $23,650 a patient. The company has raised the price several times since the drug was approved in 2010. The drug’s new cost is about four times its cost at launch in the 1990s, said Raymond James analyst Christopher Raymond. The price hikes for Enbrel and other drugs “seem to have increased in magnitude and frequency,” he said.

Imagine having an insurance card where you can walk into any doctor's office, show your card and never have to pay a bill. That's the way it is in Canada and most other advanced countries. The cost savings resulting from simplification of paperwork alone makes Medicare for All worthwhile. Bernie Sanders' message is very simple - Medicare for All will not only save money, it will provide superior health care for everybody the way it does in the rest of the world. But in America freedom implies that the owner of a life saving product can gouge its victims as much as possible in order to make profits for shareholders and investors. Wall Street frowns if the price gouging isn't to the max. To paraphrase Janis Joplin, "Freedom's just another word for the ability to price gouge."

When Elijah Cummings was grilling a smirking Shkreli in front of the House Oversight and Government Reform Committee, Cummings said to him, "It's not funny Mr. Shkreli. People are dying." But all that Shkreli and the others are interested in is maximizing growth potential and creating value for shareholders. I guess they are the only ones who count in this world. Money talks and shit walks. Then Shkreli called the lawmakers "imbeciles" for not knowing that in a capitalist economy that's par for the course.

June 28, 2014

Have you been following the news about Obamacare? The Affordable Care Act has receded from the front page, but information about how it’s going keeps coming in — and almost all the news is good. Indeed, health reform has been on a roll ever since March, when it became clear that enrollment would surpass expectations despite the teething problems of the federal website.

What’s interesting about this success story is that it has been accompanied at every step by cries of impending disaster. At this point, by my reckoning, the enemies of health reform are 0 for 6. That is, they made at least six distinct predictions about how Obamacare would fail — every one of which turned out to be wrong.

“To err is human,” wrote Seneca. “To persist is diabolical.” Everyone makes incorrect predictions. But to be that consistently, grossly wrong takes special effort. So what’s this all about?

Many readers won’t be surprised by the answer: It’s about politics and ideology, not analysis. But while this observation isn’t particularly startling, it’s worth pointing out just how completely ideology has trumped evidence in the health policy debate.

And I’m not just talking about the politicians; I’m talking about the wonks. It’s remarkable how many supposed experts on health care made claims about Obamacare that were clearly unsupportable. For example, remember “rate shock”? Last fall, when we got our first information about insurance premiums, conservative health care analysts raced to claim that consumers were facing a huge increase in their expenses. It was obvious, even at the time, that these claims were misleading; we now know that the great majority of Americans buying insurance through the new exchanges are getting coverage quite cheaply.

Or remember claims that young people wouldn’t sign up, so that Obamacare would experience a “death spiral” of surging costs and shrinking enrollment? It’s not happening: a new survey by Gallup finds both that a lot of people have gained insurance through the program and that the age mix of the new enrollees looks pretty good.

What was especially odd about the incessant predictions of health-reform disaster was that we already knew, or should have known, that a program along the lines of the Affordable Care Act was likely to work. Obamacare was closely modeled on Romneycare, which has been working in Massachusetts since 2006, and it bears a strong family resemblance to successful systems abroad, for example in Switzerland. Why should the system have been unworkable for America?

But a firm conviction that the government can’t do anything useful — a dogmatic belief in public-sector incompetence — is now a central part of American conservatism, and the incompetence dogma has evidently made rational analysis of policy issues impossible.

So, the Republicans have an atrocious 0-6 success rate on their predictions of doom regarding the ACA.It will be 0-7 after the employer...

It wasn’t always thus. If you go back two decades, to the last great fight over health reform, conservatives seem to have been relatively clearheaded about the policy prospects, albeit deeply cynical. For example, William Kristol’s famous 1993 memo urging Republicans to kill the Clinton health plan warned explicitly that Clintoncare, if implemented, might well be perceived as successful, which would, in turn, “strike a punishing blow against Republican claims to defend the middle class by restraining government.” So it was crucial to make sure that reform never happened. In effect, Mr. Kristol was telling insiders that tales of government incompetence are something you peddle to voters to get them to support tax cuts and deregulation, not something you necessarily believe yourself.

But that was before conservatives had fully retreated into their own intellectual universe. Fox News didn’t exist yet; policy analysts at right-wing think tanks had often begun their careers in relatively nonpolitical jobs. It was still possible to entertain the notion that reality wasn’t what you wanted it to be.

It’s different now. It’s hard to think of anyone on the American right who even considered the possibility that Obamacare might work, or at any rate who was willing to admit that possibility in public. Instead, even the supposed experts kept peddling improbable tales of looming disaster long after their chance of actually stopping health reform was past, and they peddled these tales not just to the rubes but to each other.

And let’s be clear: While it has been funny watching the right-wing cling to its delusions about health reform, it’s also scary. After all, these people retain considerable ability to engage in policy mischief, and one of these days they may regain the White House. And you really, really don’t want people who reject facts they don’t like in that position. I mean, they might do unthinkable things, like starting a war for no good reason. Oh, wait.

But that was before conservatives had fully retreated into their own intellectual universe. Fox News didn’t exist yet; policy analysts at right-wing think tanks had often begun their careers in relatively nonpolitical jobs. It was still possible to entertain the notion that reality wasn’t what you wanted it to be.

It’s different now. It’s hard to think of anyone on the American right who even considered the possibility that Obamacare might work, or at any rate who was willing to admit that possibility in public. Instead, even the supposed experts kept peddling improbable tales of looming disaster long after their chance of actually stopping health reform was past, and they peddled these tales not just to the rubes but to each other.

And let’s be clear: While it has been funny watching the right-wing cling to its delusions about health reform, it’s also scary. After all, these people retain considerable ability to engage in policy mischief, and one of these days they may regain the White House. And you really, really don’t want people who reject facts they don’t like in that position. I mean, they might do unthinkable things, like starting a war for no good reason. Oh, wait.

November 24, 2013

Having failed to defeat the Affordable Care Act in Congress, to beat it back in the last election, to repeal it despite more than eighty votes in the House, to stop it in the federal courts, to get enough votes in the Supreme Court to overrule it, and to gut it with outright extortion (closing the government and threatening to default on the nation’s debts unless it was repealed), Republicans are now down to their last ploy.

They are hell-bent on destroying the Affordable Care Act in Americans’ minds.

A document circulating among House Republicans (reported by the New York Times) instructs them to repeat the following themes and stories continuously: “Because of Obamacare, I Lost My Insurance.” “Obamacare Increases Health Care Costs.” “The Exchanges May Not Be Secure, Putting Personal Information at Risk.”

Every Republican in Washington has been programmed to use the word “disaster” whenever mentioning the Act, always refer to it as Obamacare, and demand its repeal.

Republican wordsmiths know they can count on Fox News and right-wing yell radio to amplify and intensify all of this in continuous loops of elaboration and outrage, repeated so often as to infect peoples’ minds like purulent pustules.

The idea is to make the Act so detestable it becomes the fearsome centerpiece of the midterm elections of 2014 — putting enough Democrats on the defensive they join in seeking its repeal or at least in amending it in ways that gut it (such as allowing insurers to sell whatever policies they want as long as they want, or delaying it further).

Admittedly, the President provided Republicans ammunition by botching the Act’s roll-out. Why wasn’t HealthCare.gov up and running smoothly October 1? Partly because the Administration didn’t anticipate that almost every Republican governor would refuse to set up a state exchange, thereby loading even more responsibility on an already over-worked and underfunded Department of Health and Human Services.

Why didn’t Obama’s advisors anticipate that some policies would be cancelled (after all, the Act sets higher standards than many policies offered) and therefore his “you can keep their old insurance” promise would become a target? Likely because they knew all policies were “grandfathered” for a year, didn’t anticipate how many insurers would cancel right away, and understood that only 5 percent of policyholders received insurance independent of an employer anyway.

But there’s really no good excuse. The White House should have anticipated the Republican attack machine.

The real problem is now. The President and other Democrats aren’t meeting the Republican barrage with three larger truths that show the pettiness of the attack:

The wreck of private insurance. Ours has been the only healthcare system in the world designed to avoid sick people. For-profit insurers have spent billions finding and marketing their policies to healthy people – young adults, people at low risk of expensive diseases, groups of professionals – while rejecting people with preexisting conditions, otherwise debilitated, or at high risk of heart disease, diabetes, and cancer. And have routinely dropped coverage of policy holders who become seriously sick or disabled. What else would you expect from corporations seeking to maximize profits?

But the social consequences have been devastating. We have ended up with the most expensive healthcare system in the world (finding and marketing to healthy people is expensive, corporate executives are expensive, profits adequate to satisfy shareholders are expensive), combined with the worst health outcomes of all rich countries — highest rates of infant mortality, shortest life spans, largest portions of populations never seeing a doctor and receiving no preventive care, most expensive uses of emergency rooms.

We could not and cannot continue with this travesty of a healthcare system.

The Affordable Care Act is a modest solution. It still relies on private insurers — merely setting minimum standards and “exchanges” where customers can compare policies, requiring insurers to take people with preexisting conditions and not abandon those who get seriously sick, and helping low-income people afford coverage.

A single-payer system would have been preferable. Most other rich countries do it this way. It could have been grafted on to Social Security and Medicare, paid for through payroll taxes, expanded to lower-income families through Medicaid. It would have been simple and efficient. (It’s no coincidence that the Act’s Medicaid expansion has been easy and rapid in states that chose to accept it.)

But Republicans were dead set against this. They wouldn’t even abide a “public option” to buy into something resembling Medicare. In the end, they wouldn’t even go along with the Affordable Care Act, which was based on Republican ideas in the first place. (From Richard Nixon’s healthcare plan through the musings of the Heritage Foundation, Republicans for years urged that everything be kept in the hands of private insurers but the government set minimum standards, create state-based insurance exchanges, and require everyone to sign up).

The moral imperative. Even a clunky compromise like the ACA between a national system of health insurance and a for-profit insurance market depends, fundamentally, on a social compact in which those who are healthier and richer are willing to help those who are sicker and poorer. Such a social compact defines a society.

The other day I heard a young man say he’d rather pay a penalty than buy health insurance under the Act because, in his words, “why should I pay for the sick and the old?” The answer is he has a responsibility to do so, as a member the same society they inhabit.

The Act also depends on richer people paying higher taxes to finance health insurance for lower-income people. Starting this year, a healthcare surtax of 3.8 percent is applied to capital gains and dividend income of individuals earning more than $200,000 and a nine-tenths of 1 percent healthcare tax to wages over $200,000 or couples over $250,000. Together, the two taxes will raise an estimated $317.7 billion over 10 years, according to the Joint Committee on Taxation.

Here again, the justification is plain: We are becoming a vastly unequal society in which most of the economic gains are going to the top. It’s only just that those with higher incomes bear some responsibility for maintaining the health of Americans who are less fortunate.

This is a profoundly moral argument about who we are and what we owe each other as Americans. But Democrats have failed to make it, perhaps because they’re reluctant to admit that the Act involves any redistribution at all.

Redistribution has become so unfashionable it’s easier to say everyone comes out ahead. And everyone does come out ahead in the long term: Even the best-off will gain from a healthier and more productive workforce, and will save money from preventive care that reduces the number of destitute people using emergency rooms when they become seriously ill.

But there would be no reason to reform and extend health insurance to begin with if we did not have moral obligations to one another as members of the same society.

The initial problems with the website and the President’s ill-advised remark about everyone being able to keep their old policies are real. But they’re trifling compared to the wreckage of the current system, the modest but important step toward reform embodied in the Act, and the moral imperative at the core of the Act and of our society.

The Republicans have created a tempest out of trivialities. It is incumbent on Democrats — from the President on down — to show Americans the larger picture, and do so again and again.

October 07, 2013

"You are here because now is the single best time we have to defund Obamacare. This is a fight we can win." SENATOR TED CRUZ, speaking in August to a Heritage Action gathering in Dallas

WASHINGTON — Shortly after President Obama started his second term, a loose-knit coalition of conservative activists led by former Attorney General Edwin Meese III gathered in the capital to plot strategy. Their push to repeal Mr. Obama’s health care law was going nowhere, and they desperately needed a new plan.

Out of that session, held one morning in a location the members insist on keeping secret, came a little-noticed “blueprint to defunding Obamacare,” signed by Mr. Meese and leaders of more than three dozen conservative groups.

It articulated a take-no-prisoners legislative strategy that had long percolated in conservative circles: that Republicans could derail the health care overhaul if conservative lawmakers were willing to push fellow Republicans — including their cautious leaders — into cutting off financing for the entire federal government.

“We felt very strongly at the start of this year that the House needed to use the power of the purse,” said one coalition member, Michael A. Needham, who runs Heritage Action for America, the political arm of the Heritage Foundation. “At least at Heritage Action, we felt very strongly from the start that this was a fight that we were going to pick.”

Last week the country witnessed the fallout from that strategy: a standoff that has shuttered much of the federal bureaucracy and unsettled the nation.

To many Americans, the shutdown came out of nowhere. But interviews with a wide array of conservatives show that the confrontation that precipitated the crisis was the outgrowth of a long-running effort to undo the law, the Affordable Care Act, since its passage in 2010 — waged by a galaxy of conservative groups with more money, organized tactics and interconnections than is commonly known.

With polls showing Americans deeply divided over the law, conservatives believe that the public is behind them. Although the law’s opponents say that shutting down the government was not their objective, the activists anticipated that a shutdown could occur — and worked with members of the Tea Party caucus in Congress who were excited about drawing a red line against a law they despise.

A defunding “tool kit” created in early September included talking points for the question, “What happens when you shut down the government and you are blamed for it?” The suggested answer was the one House Republicans give today: “We are simply calling to fund the entire government except for the Affordable Care Act/Obamacare.”

The current budget brinkmanship is just the latest development in a well-financed, broad-based assault on the health law, Mr. Obama’s signature legislative initiative. Groups like Tea Party Patriots, Americans for Prosperity and FreedomWorks are all immersed in the fight, as is Club for Growth, a business-backed nonprofit organization. Some, like Generation Opportunity and Young Americans for Liberty, both aimed at young adults, are upstarts. Heritage Action is new, too, founded in 2010 to advance the policy prescriptions of its sister group, the Heritage Foundation.

The billionaire Koch brothers, Charles and David, have been deeply involved with financing the overall effort. A group linked to the Kochs, Freedom Partners Chamber of Commerce, disbursed more than $200 million last year to nonprofit organizations involved in the fight. Included was $5 million to Generation Opportunity, which created a buzz last month with an Internet advertisement showing a menacing Uncle Sam figure popping up between a woman’s legs during a gynecological exam.

The groups have also sought to pressure vulnerable Republican members of Congress with scorecards keeping track of their health care votes; have burned faux “Obamacare cards” on college campuses; and have distributed scripts for phone calls to Congressional offices, sample letters to editors and Twitter and Facebook offerings for followers to present as their own.

One sample Twitter offering — “Obamacare is a train wreck” — is a common refrain for Speaker John A. Boehner.

As the defunding movement picked up steam among outside advocates, Republicans who sounded tepid became targets. The Senate Conservatives Fund, a political action committee dedicated to “electing true conservatives,” ran radio advertisements against three Republican incumbents.

Heritage Action ran critical Internet advertisements in the districts of 100 Republican lawmakers who had failed to sign a letter by a North Carolina freshman, Representative Mark Meadows, urging Mr. Boehner to take up the defunding cause.

“They’ve been hugely influential,” said David Wasserman, who tracks House races for the nonpartisan Cook Political Report. “When else in our history has a freshman member of Congress from North Carolina been able to round up a gang of 80 that’s essentially ground the government to a halt?”

On Capitol Hill, the advocates found willing partners in Tea Party conservatives, who have repeatedly threatened to shut down the government if they do not get their way on spending issues. This time they said they were so alarmed by the health law that they were willing to risk a shutdown over it. (“This is exactly what the public wants,” Representative Michele Bachmann of Minnesota, founder of the House Tea Party Caucus, said on the eve of the shutdown.)

Despite Mrs. Bachmann’s comments, not all of the groups have been on board with the defunding campaign. Some, like the Koch-financed Americans for Prosperity, which spent $5.5 million on health care television advertisements over the past three months, are more focused on sowing public doubts about the law. But all have a common goal, which is to cripple a measure that Senator Ted Cruz, a Texas Republican and leader of the defunding effort, has likened to a horror movie.

“We view this as a long-term effort,” said Tim Phillips, the president of Americans for Prosperity. He said his group expected to spend “tens of millions” of dollars on a “multifront effort” that includes working to prevent states from expanding Medicaid under the law. The group’s goal is not to defund the law.

June 14, 2013

This article is about the shoddy treatment of one lady by San Diego's Sharp Health Care. Her name is Donna Lichtenfels. I interviewed her by phone on Saturday, May 18. This article is based on that interview and also input provided by her daughter, who has experience in the medical field, via email. Donna was an employee of Sharp Health Care. She had gone to work there in the corporate office in August 2011, and, as a condition of her employment, she had to take Sharp Insurance called Sharp Health Plan. She had no choice in that. It was a condition of her employment. Donna has worked in the health care field for over 30 years. She started working in the field for Blue Shield of California as a claims adjuster and in fraud and abuse. She has worked for physicians and major hospitals all over the US. She also has written for several web sites, including OpEdNews, Winning Progressive and Daily Kos under her pen name, Jillian Barclay. She currently is too sick to write.

Last July after a mammogram and a biopsy, she was diagnosed with breast cancer. According to her daughter: "At the time my mother was diagnosed with breast cancer, she was being congratulated by Sharp providers because the lump had been found so early. After her mammogram (and an erroneous letter from Sharp congratulating her for a normal mammogram) and biopsy, she was informed that she was at a stage zero. This was wonderful news!

"[The surgeon] wanted my mother to have a scan prior to the lumpectomy surgery in order to ensure that there wouldn’t be any surprises when he performed the surgery. When my mother showed up for her scan, unbeknownst to her, the scanning machine was broken; yet, the Sharp staff proceeded to inject my mother with the dye. She was then informed that she would have to reschedule because the machine was broken. Apparently having the scan elsewhere (even at another Sharp location) was not an option.

"When my mother went in for the second time, the scan could not be performed because my mother had a previous neck surgery which included instrumentation. She was unable to maneuver her neck into the proper position required for the scan.

"Scheduling the surgery proved to be extremely difficult, and this is where my mother’s care by Sharp seems to spiral downward quite quickly, and my mother falls into some deep, deep crack and can’t get out. Presently, she is still stuck in this crack which is better described as a sink hole.

"The surgeon’s plan was that my mother would have her scan and her surgery would be performed after he came back from vacation. This was a matter of a couple of weeks."

Standard of care calls for surgery within a few weeks, but the surgeon kept going on vacation.

As Donna said, "The reason you find breast cancer early is so that you can get it early." She talked to her prior doctor at Scripps who told her that Scripps' guidelines are that the surgery should occur two to three weeks after having been discovered. However, when she had not been scheduled for surgery by mid-September, she complained because she knew the cancer was growing.

She called the surgeon scheduler and said "When am I going to be scheduled for surgery?" She was told, "Look lady, you're not the only person with cancer." Donna said, "I understand that, but I'm becoming concerned." The surgeon scheduler said, "Well, you know other people need this surgery too." To which Donna replied, "Sharp advertises for patients constantly. If they cannot handle the patient load that they have, why do they keep advertising?"

Donna's daughter said, "The surgeon’s scheduler is either unable to perform one of her job duties, which is scheduling surgeries, or the Sharp facilities/doctors are not large enough to handle the Sharp patient case load. I believe both to be true."

The surgeon went on one vacation. Donna was told the surgery would have to wait until he came back from his second scheduled vacation since he was booked until then. Finally, exasperated with the delays, Donna called her boss at Sharp. He was pissed, the Business Director was pissed, the head of Employee Health was furious. Some Head Honcho called or emailed the surgeon’s scheduler and read her the riot act. Donna was then scheduled right before the surgeon left for his second vacation. She would have to wait till he got back. When surgery was finally scheduled, approximately two months had lapsed from the time of diagnosis.

Finally, the day for surgery arrived.

Her daughter commented: "My impression of the Sharp outpatient surgical floor was immediate: a factory.

"I stayed with my mother in the room while she was being prepped for surgery. It was a very small room, and only one of us was allowed to be with her. I realized how chaotic everything was in the back — people hustling and bustling and even employees talking about ... what they were planning to do on their lunch breaks — so I decided that I would be able to bring my brother and sister in the back without anyone noticing.

"So that’s what I did. I walked out to the waiting room, grabbed my brother and sister and we all three casually walked into the back without anyone asking any questions. And no, we were not dressed in scrubs.

"As with most patients prior to surgery, my mother was extremely nervous. When the anesthesiologist came in, I expressed to him that my mother was anxious and nervous. I requested that he give her something to calm her nerves — this is something that is normally provided. He refused."

"The surgery wasn’t very long. It was scheduled in the noon hour and was completed before 1:00 PM. Sitting in the waiting room, I would see surgeons come out and visit with family members explaining how the surgery went. This did not happen with my mother’s case. It dawned on me later that the reason for this was because he squeezed my mother’s surgery into his lunch hour due to the Sharp Head Honcho e-mail. [ed.note: Donna had used her employee contacts at Sharp to get an earlier surgery date.] Lunch was the only open slot before his next vacation."

After the surgery the surgeon did not speak to her or her kids. She found out later that the surgery disclosed that the tumor had doubled in size. She went into surgery with the expectation that a lumpectomy would be performed. As it turned out, they did a partial mastectomy. The doctor had not informed any of Donna's family that the surgery had been more extensive than planned.

Donna's daughter wondered: "I wonder about two things: If the surgery had been performed in a timely manner, would the cancer not have spread? Secondly, if it was known on the day of the surgery that the mass had grown much larger (however, [this would have been tantamount to] admitting an error in delaying surgery), would a mastectomy, then, have been the appropriate course of treatment, and would the cancer not have spread?"

On the way home from the hospital, Donna noticed that during the surgery they had knocked out a tooth and given her a fat lip. "My mother also complained about being extremely sore—not at the surgical site—but all over her body to include her arms and legs. These complaints, in my opinion, were in line with being dropped, nearly dropped or handled very roughly, all which would have occurred during a bed transfer." No explanation was forthcoming. When Donna talked later to the surgeon, he told her he had no idea how that had happened. She filed a complaint with Sharp's Quality Assurance only to be told that the doctors there were individual contractors, and, therefore, Sharp was not responsible. Having worked there as an employee, she knows this is a lie. They are paid a salary by the same people that she was paid a salary by.

After she got home and some time had passed Donna noticed that she had a wound infection from the surgery. She called the hospital and was told that she was in luck. It so happened that her surgeon was on call that weekend and he would for sure call her back. He never called. Later he told her that he was not on call. There is no way to prove this because all hospital records are confidential. Even when the matter was taken up with Quality Assurance, there was no way for Donna to resolve this because all Quality Assurance deliberations are confidential. She said, "All complaints that I've made to Sharp have gone on deaf ears." She continued, "They don't treat you like a whole person. Everybody passes the buck."

"My mother wrote a complaint to Sharp about her Sharp Experience. She received a letter explaining that PART of the complaint would be addressed at some board meeting and she would not be privy to any of it including any action that might be taken. The letter also informed her that other PARTS of her complaint needed to be sent to such-a-such a place and such-a-such a place, because apparently certain aspects of care are handled by different entities despite the whole fiasco occurring in one place. If I remember correctly, the letter indicated that she would need to write these complaints separately, because Sharp would not be forwarding the complaint to the proper entities."

A PET scan showed the cancer had spread to her lungs. She went on radiation therapy. After two weeks of radiation she went in for a CAT scan which discovered there was a mass in the lungs which they had not told her about. She went back to the radiation oncologist and asked to see the CAT scan herself. That's how she found out about the mass. The oncologist told her "At this point the Tumor Board is going to meet." The Tumor Board said that the (by then) three masses were too close to the heart to do a normal biopsy.

"My mother had gone from a stage zero to a likely stage-four cancer case in a matter of months."

In order to determine if it was indeed metastatic breast cancer or a separate lung cancer, the oncologist pushed for a very risky open heart procedure just to get a biopsy. Even with a biopsy, treatment would not change. Either way the chances for survival are not that great. Donna refused the open heart surgery. She stopped radiation and went on Arimidex, a hormonal therapy, which made her very sick. Her body swelled up to three times its normal size. She could hardly talk. She could not walk. Her oncologist decided to take her off Arimidex and wanted to start her on Temoxiphen.

"My mother was put on a chemo drug called Arimidex. There were two choices: Arimidex or Tamoxifen. Arimidex was chosen because it was thought the side effects would be less severe than the other drug. My mother began coughing, her voice was very hoarse and her legs swelled so badly that she was referred for a Doppler to determine if there was a blood clot. The side effects of the drug worked quite quickly."

"She complained to her primary care doctor about ... back pain. The Primary Care Physician (PCP) refused to increase her pain medication and/or change her pain medication. Diagnostics were not ordered to even confirm my mother’s reason for excruciating and debilitating back pain.

"Her primary physician also explained she was unable to fill out paperwork for a handicapped parking permit, because the state, for some reason, had taken away this privilege. I conclude that this was done because English is the physician’s second language. There is a language barrier and a problem with communicating, especially on paper, exactly what is going on. The PCP has a problem with forms."

Tamoxifen has been known to cause back pain, but Donna's back pain was due to a different problem that she had had for years. Nevertheless the oncologist decided to take her off Tamoxifen. The oncologist did not order diagnostics in order to determine the etiology of the back pain, whether it was from the Tamoxifen or from an unrelated condition. At this point she had no treatment plan for cancer.

"My mother called me the next morning hysterical. She said that the oncologist had mentioned that discontinuing her meds might allow the tumor in her lung to grow more rapidly so a biopsy could be performed. I instructed my mother to continue the treatment, because no course of treatment and/or no treatment plan seemed outrageous and unsound medical advice.

"I instructed her to call up her ortho from Scripps to obtain any CT’s and MRI’s that were performed on her spine in order to prove to the Sharp physicians that my mother has a severe back problem that needs to be addressed, and to prove that the back pain is not related to the cancer treatment; therefore, restarting the Tamoxifen would be appropriate and life extending. I told my Mom I would go to the PCP office visit with her.

"The years’-old MRI showed that there were disc bulges and protrusions in her lower back in the area of her complaints. The PCP seemed to have a sudden realization that, wow, my mother was actually in pain and was not a drug-seeking patient after all.

"I explained to the PCP that not only would my mother need an appropriate course of pain meds to control the pain, but that she should be taking the Tamoxifen for the cancer since the back pain was not related to the chemo drug.

"The PCP was quite perplexed. Was the radiation therapy already completed, she asked. I was astounded that the PCP had no knowledge of the radiation therapy being stopped despite my mother seeing her on a regular basis. I explained to the PCP why the radiation therapy had been terminated, that Tamoxifen was prescribed and was just discontinued due to this obviously unrelated back pain.

"'No treatment?' She asked me.

"I shook my head, no.

"'No treatment?' She asked aloud again.

Again, I shook my head.

"'No treatment.' This time it was an amazed statement."

"The PCP did not address the Tamoxifen during this visit. She did not say whether to start up or discontinue (it’s not her place apparently). She did, however, increase the pain meds slightly and referred her to a specialist. This referral, however, was put on hold for a few minutes while the PCP posed to us a question, “But what if the specialist says that surgery is indicated?” The PCP was basically saying that if my mother didn’t want a surgery, then what is the point of seeing a specialist?

"Wow.

"I explained that we will deal with the treatment plan when we find out exactly what was going on, but that a major concern, for me—as my mother’s daughter—was the Tamoxifen being discontinued for no reason and having the cancer spread more rapidly. I attempted to have the appointment with the specialist scheduled. I waited nearly 30 minutes at the receptionist’s desk while she attempted to get in touch with the specialist’s office to schedule an appointment. I would have waited until it was complete, but my mother was extremely exhausted and she was in obvious distress due to the back pain.

"The receptionist expressed forced exasperation for my behalf at not being able to speak with anyone, and she was obviously not happy that I was looming over her during this process. I also got the feeling she needed to go to lunch since she began every sentence with “they are all probably at lunch”. I was assured that my mother would be contacted with the appointment date and time later that day. My mother was never contacted that day or any day thereafter. Out of sight and out of mind.

"My mother just recently had her visit, which I believe she scheduled herself. The specialist informed her that she has a large cyst at the base of her spine which is causing the extreme pain — and of course the pain is compounded by the disc bulges and protrusions. Getting rid of this nasty cyst would be a major surgery and surgery is not an option, according to the specialist. The pain is expected to progressively worsen and my mother will be wheelchair-bound eventually. Still, no handicapped parking permit, and still a struggle with the PCP for pain meds.

"At this visit, my mother apparently broke down and began to cry when the specialist refused to fill out her disability papers. He told my mother that she needed to have her PCP fill out the papers. He [finally] did fill them out for her because the tears worked.

"The disability is another problem, but it goes to show that the Sharp doctors have no understanding of anything outside their boxes. My mother explains it best when she says that each physician treats one piece of her, and there is not one Sharp physician that treats her as a whole. I additionally wonder if Sharp realizes that she is a person with a family, and not just a case.

"The oncologist rationalizes that he is unable to put my mother out on disability because he has patients with stage four cancer that continue to work. Why can’t she? Perhaps she should see the ortho for her back and have him fill out disability papers for her back problem. Or maybe her PCP should fill out the papers?

"Her PCP refers her to the oncologist since she has breast cancer or the specialist for her back despite the specialist visit being a consult."

Donna related, "But all through this whole thing there has been no coordination of care. My primary doctor was shocked when she found out two months after I stopped radiation that I wasn't doing radiation therapy. She had no idea. There's been no coordination of care and I think that that is what I'm most upset with. In all of their advertisements they tout that they have coordination of care, a cancer care coordinator that makes all of your appointments for you, does this, who does that. Not true. It doesn't happen."

Donna's daughter again: "Throughout this time, my mother has been put on disability and taken off of disability so many times that it has impacted the amount of money she collects. Each time she receives a smaller check. Nobody wants to step up and fill out the paperwork.

"Understand, this is for TEMP disability when what my mother really needs is PERMANENT disability. I have told my mother to schedule an appointment with her physician she used to see at Scripps in order to have that physician fill out permanent disability, and that I will pay for everything in cash."

Donna has been on medical leave of absence from Sharp since last October. Her history of serious spinal degeneration has made it nearly impossible to walk. She is diabetic and has other chronic medical issues as well that have been largely ignored by Sharp. From the very beginning of her treatment, there have been serious medical errors made and no one will address them. Now, the lack of coordination of care is affecting not only her health but her financial situation as well.

"So the last visit that I had with my oncologist was on April 22. He had received a letter from Sharp, my employer, asking him to fill out paperwork for an extension of my leave of absence. I brought him a copy, on that date, of the paperwork just to make sure he had it. I stressed the importance of getting this back to my employer. He promised me, he assured me, he would ... and he did not send in the paperwork to Sharp, my employer, his employer, and I just last week got a letter from Sharp saying that, because my doctor did not send in the paperwork, I was considered to be vacating my position. So I am no longer employed by Sharp."

Donna's daughter relates: "Nobody wants to fill out any paperwork. It’s out of their boxes. For icing on the cake, the oncologist failed to fill out some paperwork from Sharp Human Resources. As a result, my mother received a certified letter from her employer indicating that the lack of response from the oncologist indicates, to Sharp, that she has voluntarily vacated her position (which is why she is on Cobra).

"My mother is now paying for Cobra. I believe this is $600 monthly. Because she has been on temporary disability, she does not qualify, at this point, to receive Medicare. Ideally, the paperwork needs to be submitted for permanent disability so she does not have to worry about the extra expense of Cobra, as well as the depletion of the Cobra. She should not have to worry about who will be willing to fill out the papers for the next extension of, my God, TEMPORARY disability. My mother should not have to worry about how to pay her bills to maintain the standard quality of life for basic necessities like water, heat, and her self-prescribed Pepto-Bismol since Sharp is not addressing her rapid weight loss."

Donna's last visit to the oncologist was April 22. He kept pushing for an open heart biopsy and she said no. Donna said, "You don't biopsy someone if the surgery is going to kill them."

Donna said: "I've never seen anything like it. I've NEVER SEEN anything like it, and I was shocked and even the people that I worked with were shocked. And every time I would ask someone, a fellow employee, 'give me the name of a good doctor at Sharp', [they said] 'ah well I wouldn't recommend my doctor'. Now that's not a very good recommendation coming from an employee."

She has no choice but to stay with Sharp physicians and Sharp Health Care. She said, "All complaints that I've made to Sharp have gone on deaf ears." She continued, "They don't treat you like a whole person. Everybody passes the buck."

This is the Sharp Experience. It takes two months just to get an appointment with a specialist. Despite the shoddy experience and lack of caring Donna experienced, Sharp advertises on its website, "We are now an organization filled with passionate, determined and caring people — all dedicated to transforming the health care experience for our patients and their families." This is totally false according to Donna. The Sharp Experience she experienced was uncoordinated, uncaring, a lower standard of care than is common in the industry.

Donna told me, "In all my years of working in this field I have never experienced such substandard, negligent medical care. I don't know if I have just been unlucky or if this is a system-wide issue with Sharp. The lack of coordination of care seems to be the root of the problem." At Sharp the right hand doesn't know what the left hand is doing. There is no coordination among the various doctors responsible for her health. The oncologist doesn't communicate with the primary doctor who doesn't communicate with the radiologist who doesn't communicate with the surgeon who doesn't communicate with the ortho. Nobody seems to know what is going on. In Donna's words, despite all the TV advertising Sharp does, "The Sharp experience is not a good one. Sharp is a sham."

Because of her extensive experience, Donna says, "I know a lower standard of care when I see one." I asked her if she thought Sharp had a financial incentive for the shoddy care she received. She said "no" although Sharp Health Care is all about maximizing profits. They are always asking for donations even from their employees. Their nominal non-profit status is basically a sham as it is for most other non-profit hospitals as was debunked by Steven Brill in his exhaustive Time article, "Bitter Pill."

However, I question whether there might be a financial motive in delaying Donna's surgery and for her uncoordinated care. In her case, no money changes hands at Sharp. If she gets a PET scan, since Sharp self-insures, it's something Sharp basically does for free, and I think that is the catch. Just as the shoemaker's children are the ones that go without getting the holes in their shoes repaired, there is no money in it for Sharp to take care of their employees who are on the Sharp Health Plan. They have a financial incentive to take care of those who are on Medicare or private insurance because they represent money coming into the system. In Donna's case, as she said "no money changes hands."

Under her pen name Jillian Barclay, Donna, has written extensively about the health care industry. This is from her bio on HubPages:

"My work experience has mostly been in the financial end of healthcare, either tracking fraud and abuse for one of the largest insurance companies in the country or maximizing money for doctors and hospitals. I also spent a fair amount of time acting as a utilization review coordinator for a now defunct Medicare Advantage program (losing that job because I saw fraudulent treatment denials for senior citizens and reported it to the FBI). I also successfully sued that corporation because of their practices. I have worked as a Patient Advocate, helping people who don't know how to handle denied claims or treatments."

Donna's daughter ended her writing to me as follows:

"My mother attempted to find legal representation. Nobody wants to take on Sharp, and she was also told to tell her kids to come back after her death in order to revisit the possibility of a case. Every day that goes by, my mother has less and less energy. I have tried to push her into finding a smaller-time attorney who would be successful in obtaining a small monetary settlement just so she is able to live without worry. This is what I want for my mother. I don’t want to hear the fear in her voice about not being able to afford her meds, electricity, etc.

"Most of all, I just want my mother to receive proper treatment, because the care from Sharp has been sub-standard, at best. It literally is a nightmare that nobody should ever have to deal with."

It's ironic that someone like Donna who has been a Patient Advocate, who has helped numerous people deal with fraud and abuse in the health care system, should now be in the position of needing help dealing with the very health care system she has helped so many others deal with.

Update from Donna: Had a brain MRI yesterday (June 11), no results yet, AND I stopped in at Human Resources - I explained the oncologist's promise to send in the necessary paperwork- she was shocked that he had not done it and told me that if I get better, to come back and they would "probably" rehire me. She said "it was never a performance issue."

May 21, 2013

Was the
Congress, Fed, and Treasury Rescue of AIG the Right Decision in 2008?

Frank Thomas says "Yes." John Lawrence says "No."

Frank's take:

David
Stockman: “We Should Have Let The Market RIP, AIG Fall … and Lived With The Consequences”

Introduction

In
his book, The Great Deformation, David
Stockman presents a broad “no prisonerstaken” indictment of our
systemic social-financial-political maladies or ‘deformations.’ I share his
view we have descended to a gamed, distorted system where almost “nothing
is working” coherently that can save it from the next Boom-Bubble-Bust implosion
unless there is fundamental change.

Stockman’s
Austrian libertarian advice is that government should stop governing. Back to the pre-Roosevelt Carter Glass era of
financial discipline under the gold standard and the Fed operating as a passive
banker’s bank, making loans and accepting deposits. Bad government and
pernicious Keynesian economics are core causes of our present ills that justify
a turnabout to self-correcting “unfettered market capitalism” of Hoover,
Coolidge and everyone before them … this is farfetched, to put it mildly.

Stockman’s
brave new world of a self-policing system of unfettered market policies
free of government interventions and strict financial regulations – a radical
idea with no hard numbers on the human costs, job losses, business failures –
is ironic. This is just what we have had
a good taste of over the last thirty years! And all it has brought us is a world of energized greedy forces and financial
wizards who can burn the house down and make a fortune at it!

Given
Stockman’s deep anti-government, anti-Keynesian mindset, it’s no surprise he favored letting AIG and major banks fall. In his words: “despite creating lots of job losses and lots
of pain lasting for a generation … this action would create lessons, it would
create discipline … new firms would grow out of the remnants of
AIG, Goldman Sachs, Morgan Stanley, etc. … bank bailouts were unnecessary … the
Main Street banking system was never in serious jeopardy ... the
money market industry wasn’t imploding.”

These
presumed ‘gospel truths’ need to be viewed against what actually took place in
financial markets during the bubble crisis times of 2006-08. I shall leave it to the reader to decide
whether the Congress, Fed, and Treasury acted appropriately in bailing out AIG at
a point in time the economy was entering a mini-depression and the worldwide
financial industry was under exceptional strains from many directions.

Why Did The Fed Recommend Rescuing AIG?

Ben
Bernanke gave a ‘right to-the-point’ answer to this question on CBS TV March 10,
2009 – the essence of which he repeated to the Committee on Financial Services,
House of Representatives March 24, 2009.

“Of all the events and all the things that
we’ve done in the last 18 months, the single one that makes me the angriest, that
gives me the most angst, is the intervention with AIG. … Here was a company
that made all kinds of unconscionable bets. Then, when those bets went wrong,
they had a – we had a situation where the failure of that company would have
brought down the financial system.… In deciding torescue AIG, the government
worriedthat if it did not bail out the company, its collapse could lead to acascading
chain reaction of losses, jeopardizing the stability of the worldwide financial
system.” (note: wrong says Stockman as regular bankruptcy
would have worked for all the mega financial institutions … we didn’t need Goldman
Sachs, Morgan Stanley, Bear Stearns because
Main Street banks didn’t own toxic assets like securitized mortgages (CDOs) and
credit default swaps (CDSs).

In
the 2nd half of 2008, global markets were experiencing
unprecedented, multi-dimensioned financial pressures and a worldwide loss of
confidence. In Bernanke’s words to the Committee on Financial Services March
24, 2009:

“I
will describe why supporting AIG was a difficult but necessary step toprotect
our economy and stabilize our financial system. …The Federal Reserve and the
Treasury agreed that AIG’s failure under the conditions then prevailing would
have posed unacceptable risks for theglobal finance systemand
for our economy” (note: wrong says Stockman who casually dismisses as
extreme fears the catastrophic implications and global ‘contagion’ from an AIG
failure in 2008 – “There will be lots of pain … butlet themarket
rip and live with the consequences”).

What
were the extraordinary financial risks that had been building up during 2005-08?

Derivatives allow
the sharing or redistribution of risk.
BUT, they can blow up in a BIG way by the high leverage and non-transparent
buildup of risk inherent in derivative CDO/CDS contracts – especially when used
recklessly such as tools for speculation which can lead to taking on too much
risk. Non-transparency, opacity, extreme
complexity, counterparty risk are the primary risks in the OTC [Over the Counter] derivativesmarket. The opacity and complexity caused
by financial entities interlinked by a large number of non-transparent
derivatives contracts means the default of one party could cause severe damage
to the credit soundness of its counterparties leading to a broad market
disruption. As stated in a joint Treasury and Financial Services Authority
paper on CDS trading, “ The private
nature of contracting with limited public information, the complex web of
mutual independence, the difficulties of understanding the nature and level of
risks increase uncertainty in times of market stress and accordingly pose risks
to financial stability.”

In Sept. 2008,
Lehman Brothers’ default was the first
example of a major counterparty failure to meet obligations on its debt and
CDS derivatives. Lehman’s $600 billion bankruptcy broke all world records and
led to the failure of other institutions that had substantial derivatives
exposure. Financial tremors erupted
globally on fears of systemic defaults becoming extreme. Lehman exposed the
systemic weakness of having many counterparty credit risks that were not fully
transparent nor given much attention. To correct this, CDS risk mitigation techniques
have been initiated, e.g., bilateral netting and overcollateralization of swap
liabilities as effective ways to address counterparty credit risks in CDS
markets. Also, a “central clearing house” proposal for CDS transactions is a
sound step in making these transactions more transparent.

Fueling the fear
of ‘financial contagion’ was the spreading of toxic asset risk and threat of
bankruptcy to Freddie Mac, Fannie Mae, Washington Mutual, Ambac – right when employment, new jobs, disposable
income and GDP growth were plummeting. The placing of Freddie Mac and Fannie
Mae under conservatorship added to the tension in financial markets.

Another
factor at the root of the 2008 financial crisis were U.S. accounting rules for
reporting derivative risk from mortgage securitizations (CDOs) and credit
default swaps (CDSs). U.S. accounting
rules, unlike those in Europe, allowed banks to report a much smaller portion
of their total derivatives risk. This reporting omission enabled banks to erase
trillions in assets and keep trillions of mortgage-linked bonds or derivative
liabilities off their balance sheets. This intensified the non-transparency and
inadequate control of derivative products. Fortunately, corrections to this reporting
omission have been made. Major U.S. financial institutions are now reporting
their full notional and net derivative exposure on the balance sheet.
Hopefully, this move away from opaque, non-transparent financial statements will
ensure banks are more cautious in using derivative instruments in a manner that
doesn’t explode in their faces in times of distress.

Mortgage
securitizations kept off the balance sheet became a costly shock when banks had
to repurchase home mortgage loans sold to special investor vehicles on a huge
scale. Also, AIG’s derivatives contracts required large collateral payments if
its AAA credit rating was downgraded as it was in Sept. 2008 – causing a
massive liquidity squeeze. This and AIG’s huge CDS positions led to a reported $99 billion loss in 2008. To stabilize the situation for large Wall
Street firms making markets in CDS contracts, the Treasury decided to extend to
AIG a secured credit facility of $85 billion. This exploded to $182.5 billion after
the insurer couldn’t pay banks on derivatives tied to those home mortgage loans.
In exchange for this financial investment, taxpayers secured a whopping 92% ownership
of AIG!

AIG’s $1.8
trillion notional derivative risk exposure was intricately connected with
financial parties worldwide, including 21 auxiliary holdings and millions of
policy holders who were also counterparties. The insurer ended up owing multibillion dollar
payments to Merrill Lynch, JP Morgan, Bank of America, Goldman Sachs, Citigroup
– in all, 80 companies and municipalities including major European banks like the
Deutsche Bank, Societe Generale of
France, UBS of Switzerland, Barclays of Britain, etc. (Barclays and Citigroup
were customers of AIG’s securities lending program, not derivatives). Government
due diligence analyses of the books confirmed the potential breadth of losses were
stupendous – posing a dangerous chain reaction that Stockman downplays but Congress,
the Fed and Treasury did not! Officials feared the sheer market shock from an
AIG failure would precipitate a global financial breakdown of systemic proportions.
So this was another reason why government
officials decided to bail out AIG and by doing so, its major counterparties
who had taken on enormous, irresponsible CDO risks.

Another
system risk is that “AAA” rated firms, like AIG, were presumed to be safe. They
didn’t have to post any collateral to the practically unlimited derivatives they
were allowed to create out of thin air.

Other
potential risk exposures tied to an AIG failure were specified by Ben Bernanke
before the Committee on Financial Services, U.S. House of Representatives March
24, 2008. In Bernanke’s words:

AIG would have
likely been put into rehabilitation by their regulators leaving policy holders
facing considerable uncertainty about the status of their claims. AIG’s
insurance subsidiaries had considerable exposure to AIG’s Financial Products
unit that would have weakened them if the parent company went bust.

State and local
agencies that had lent $10 billion to AIG would have suffered losses.

Workers
whose 401(k) plans had purchased $40 billion of insurance from AIG to insure a stable
fund value against a decline in value would have seen that insurance disappear.

Global banks
and investment banks would have suffered losses on loans and lines of credit to
AIG and on derivatives with AIG’s Financial Products unit. The banks combined
exposure here was $50 billion.

Money market
mutual funds holding approximately $20 billion of AIG’s commercial paper would
also have taken losses, exacerbating direct effects of a default on AIG
counterparties.

Once begun,
a financial crisis can spread unpredictably. For example, Lehman’s default on
commercial paper caused a major money market fund to “break the buck” and
suspend withdrawals, igniting a general run on prime money market mutual funds
and in turn causing severe stress in the commercial paper market.

Uncertainties
about the safety of insurance policy products could have led to a run on the
broader insurance
industry by policy holders and creditors.

Market
financial participants knew that many institutions had large exposures to AIG. Its
failure would have led market participants to pull back more from commercial
and investment banks – escalating even more pressure on those institutions.

Finally, a
very critical point raised by Bernanke was that federal bankruptcy laws do NOT
sufficiently insure the orderly resolution (e.g., dissolution) of nonbank financial institutions when a
failure poses substantial systemic risks. Lacking this no federal agency could put
AIG into conservatorship or receivership to unwind slowly to protect
policyholders and impose appropriate losses on creditors and counterparties.
Also, no federal agency could provide capital to stabilize AIG. However, the
Federal Reserve did have the authority to lend on a fully secured basis,
consistent with its emergency lending authority provided by Congress and the
Fed’s responsibility to provide financial stability.

April 19, 2013

The best antidote for a degenerative disease is a regenerative lifestyle

The health care system, what I call the medical-industrial complex, is in reality a disease management system. It does little to promote health and makes money only when people get sick or injured. Doctors only make money when they treat a sick patient. They make nothing for keeping them well. This is the so-called fee for service model and it stinks. It drives up disease care costs. Pharmaceutical corporations create drugs and advertise them on TV in order to get as many people as possible hooked on them. Doctors do little to treat underlying diseases but willingly prescribe drugs to ameliorate symptoms. The big money is in surgery.

Obamacare, aka the Affordable Care Act, while it has placed into law important provisions such as disallowing rescission, disallowing kicking people off of health insurance policies due to preexisting conditions, providing for not quite universal coverage etc, it does little or nothing to actually make health care affordable. Hospitals charge exhorbitant rates according to their Chargemasters. In some cases they won't accept a patient's insurance coverage, demanding upfront payment in cash instead. Obamacare does little to keep pharmaceutical costs, health insurance costs or hospital costs down.

I have written a number of critical articles about the health care system. But I don't want to leave the impression that all I'm doing is to just tear this leviathan down in a critical and negative way and have nothing positive to say regarding the health care system. I do have some postive suggestions about how it could be improved. Since doctors, hospitals and pharmaceutical corporations only make money when you get sick, they have no financial incentives for keeping you well. If you never got sick or injured, they would all go broke. The financial incentives are totally misaligned.

So here is my modest proposal: pay doctors only for keeping you well. This system could be implemented as follows. Put doctors on a base salary plus bonuses and minus penalties. The base salary should be sufficient so that doctors would want to become genaral practitioners or family doctors and not just specialists. Today the opposite is the case. Most doctors want to become specialists, and not family doctors, because that's where the money is. This situation needs to be reversed.

There should be positive bonuses and negative penalties. On a per patient basis, the cost per average patient for a year's medical services could be computed. This cost would be adjusted for the age, gender and geographical location of the patient. If a patient consumed less disease management services than average, the doctor would be paid a positive bonus up to the amount of money saved. On the other hand if the patient consumed more than the average amount of disease management services, a negative penalty would be taken away from the doctor's base salary.

Patients would have to be assigned on a somewhat random basis so that any particular doctor would not wind up with all healthy or all unhealthy patients. The negative penalties are necessary so that a doctor would not just concentrate on his healthier patients and write off the unhealthier ones.

With such a system in place, the financial incentives would be lined up correctly. There would be a tremendous savings in the cost of health care. Doctors would be paid for keeping patients well and not just for taking care of them when they were sick. Of course taking care of the sick in order to restore them to health would still be a significant component of health care. The negative penalties would align the doctor's incentives to get the patient well as soon as possible in the least costly way.

With such incentives there would be more resources, attention and research devoted to understanding what makes for a healthy lifestyle. Much of this is already known and in fact is common sense. One of the main things a doctor would do is to get his or her patients to stop smoking. The next thing is weight management. Who knows -doctors might even be incentivized to hold fitness classes in their offices. Diet, nutrition and exercise are the basic components of a healthy lifestyle. Doctors would see their patients regularly and sit down and talk to them about their lifestyles and what makes for a healthy lifestyle instead of the incentive today to get the patient in and out of the office in six minutes in order to make any money.

Doctors would advise their patients to stay away from processed foods and foods containing a lot of sugar, fat and salt - all the things which food manufacturers put in in order to make food taste better. Instead of drugs to make patients less sick, doctors would advise their patients about vitamins and food supplements. Doctors would advise their patients to stay away from GMO foods, foods which have been genetically modified so that they can be sprayed with large amounts of pesticides and herbicides with no negative effects to the plant but not necessarily no negative effects to the human who eats the plant. Fruits and vegetables sprayed with pesticides and herbicides contain carcinogens since most chemicals ingested or otherwise taken into the body are carcinogens.

Therefore, doctors would advise their patients to consume organic foods as much as possible and to limit "eating out" since the aim of most restaurants is to make food taste as good as possible while at the same time adding preservatives to lengthen the shelf life. Even expensive restaurants are using highly sprayed and chemically altered foods unless the menu specifically says that the foods are organic. In particular fast food restaurants are to be avoided because all foods served there are ones that have been acquired from industrial farmers who use pesticides, herbicides, preservatives, antibiotics and hormones because these foods are the cheapest to produce and the cheapest to consume.

Meat and farmed fish, unless they are organic, contain large amounts of hormones and antibiotics and are raised and killed under ghastly conditions for the animal's health and well-being not to mention the health and well-being of the humans who consume them. Only wild caught fish should be eaten and beef, pork and chicken that have not been fed GMO or pesticide and herbicide sprayed foods. Doctors would have to become experts in nutrition something they do not even have a course in in medical school today.

Exercise and lifestyle are important components of a healthy life. Aerobic exercise such as swimming and running are probably the most important forms, but weight training to develop muscle mass in also important especially for older people who tend to lose it. An exercise program appropriate to a patient's age will be developed by caring doctors. There should be emphasis on non-competitive sports since how fast or strong or agile a patient is is not important. What is important is keeping a patients's body operating at a highly functional level. A lot of people who are not athletic have never been encouraged to exercise for the sake of the health benefits it brings. Even competitive athletes often become sedentary once their competitive careers are over. The point isn't to win a contest; it's to improve one's health and stay alive.

People need to exercise on a daily basis and try to stay "in shape." There is a difference between random exercise and exercise that keeps the cardiovascular system operating at a high level. Any athlete knows the difference between being "in shape" and just tossing a football or a basketball around occasionally. Generally, if one gets winded with moderate exercise, one is not "in shape." If you can run or swim continuously for a half hour or more, and do this on a daily basis, you are probably in pretty good shape.

There needs to be more research done on the benefits of exercise in disease prevention, but most of the reserach goes into developing drugs for disease treatment rather than into creating the preconditions for preventing disease in the first place. The best antidote for a degenerative disease is a regenerative lifestyle. The body will regenerate itself if given a chance through diet and exercise. High levels of blood oxygenation which come about from exercise can probably flush away the precursors of disease and stagnation in the body just as a free flowing stream is healthier than a stagnant pond. Why is nobody studying this? Because there's no money or Nobel prize in it?

A nonsedentary lifestyle should be encouraged. Sitting behind a desk for 30 years in a professional career is not good for maintaining a healthy body. Mild exercise during one's work hours combined with aerobic and weight training in a patients's recreational time should lead to the best results. The American lifestyle of sedentary work combined with hours spent watching TV while consuming junk food is the worst possible lifestyle.

Our bodies were designed as hunter gatherers. Instead the American Way of Life promotes sedentaryness at an early age. Kids are taught to sit and be quiet from preschool on. For those who rebel against this lifestyle, they are diagnosed as ADHD, Attention Deficit Hyperactivity syndrome and, of course, prescribed a drug at an early age - Ritalin. This gets them on the treadmill that, for every problem they face in life in not conforming to the American system, there exists a drug to take off the rough edges and make them perfectly docile and compliant. The goal is to make them docile and compliant workers and consumers.

Doctors need to get involved in advising their patients about lifestyle. A low stress lifestyle will lead to a more mentally and physically healthful life. Avoiding high stress occupations is an important part of choosing a career. Although the workstyles of those who do physical work is looked down upon in many quarters, those occupations may be the least stressfull and have the most beneficial results compared to sedentary workstyles and lives.

An article in a recent issue of Time magazine was entitled "How to Cure Cancer" which was emblazoned in large type across the cover. In all due respect, they are missing the point. The point is not how to cure cancer but how to prevent cancer in the first place. Cancer in many but not all cases can be prevented by lifetyle choices. The main and obvious one is not to smoke. But also to stay away from chemicals in the environment as much as possible. Recently a Marine former drill sergeant traced the dealth of his six year old daughter to cancer to the contamination of well water at Camp Lejeune by a local dry cleaning company which dumped toxic dry cleaning chemicals on the ground instead of disposing of them properly. He was recently acknowledged at the White House for his work on tracking down the problem and probably preventing many other cancer deaths.

There may be no Nobel prize involved for a doctor who keeps his patients healthy as there might be for a doctor who studies molecular biology and discovers a cure for cancer. All the prestige and the money and the interesting work is in the frontiers of science, but the true doctor heroes are the ones who care enough about their patients to get them to stop smoking, eat healthy foods, drive cautiously, keep their weight down and exercise.

Even if there is a cure for cancer in terms of developing drugs which can shrink tumors, there is no guarantee that new tumors won't eventually grow as long as the preconditions for cancer continue to exist. The important thing is to live a healthy lifestyle so that most cancers cannot get a toehold in the first place.

So there is my modest proposal for improving the health care system and keeping health care costs down. The important thing is to align financial incentives as much as possible with keeping patients well instead of charging them for instances of disease management when they get sick.

April 08, 2013

According to an article in the Washington Post on April 3, 2013, doctors are now turning away cancer patients who can't pay out of pocket. We previously reported how MD Anderson, a leading cancer hospital in Houston, Texas demanded an upfront payment in cash from Sean Recchi before he would even be admitted to the hospital. The patient by the way had health insurance. The admitting agent told him, "We don't take that kind of discount insurance." Fortunately, a family member was able to write the check for $83,900. that was demanded before treatment would begin.

Now doctors are doing the same thing - refusing to administer life saving drugs to Medicare cancer patients using the rationale that they they would be losing money because their payments from Medicare are reduced 2% by the sequester. To hear the doctors tell it, they would be put out of business by the smaller payment. However, a little simple math (something that neither the complaining doctors or the writer of the Post article evidently can do) shows that the doctors would still be making money even with the reduced payment. And since they have a ton of other ways to bill patients over and above the bill for the administration of the drug, they still would be making plenty of money. They are just miffed that they wouldn't be making quite as much money as before so they are taking a page out of the hospitals' book and demanding payment or at least the difference in payment in cash from the patient upfront before administering the drugs.

“If we treated the patients receiving the most expensive drugs, we’d be out of business in six months to a year,” said Jeff Vacirca, chief executive of North Shore Hematology Oncology Associates in New York. “The drugs we’re going to lose money on we’re not going to administer right now.”

That's absolute poppycock and here's why. Medicare is subject to a 2% reduction under the sequester. Doctors are paid the average of what the pharmaceutical companies charge for the drug which is outrageous in itself but no skin off the doctor's nose. In addition doctors were paid an additional 6% for storing and administering the drug.

Say a drug cost the doctor $10,000. for one dose (not atypical of today's prices which can be at least double that amount for some drugs). So the doctor would be paid $10,000. + $600. or $10,600. prior to the sequester. After the sequester the doctor is now being paid 2% or $212. less. So the doctor is paid $10,388. The doctor pays the drug company $10,000. and is left with $388. How is this losing money?

However, Vacirca stated that from now on his clinic would start turning away a third of their patients under the ruse that the more expensive the drug, the more money they would lose. But the simple math above belies that fact. In fact the more expensive the drug, the more money Vacirca's clinics make for doing the same thing - administering a shot. It costs the doctor no more time or effort to administer an expensive shot than it does to administer a cheap shot. Moreover, the doctor will receive more money from Medicare for the expensive shot than for the cheap shot because he is paid on a percentage of cost basis. Vacirca, however, wants you to believe that the 2% reduction on the price of the drug swallows up the 6% the doctor formerly made. Not so. As the drug gets more expensive, the percentage the doctor gets for administering the drug also increases so that the final result is that the doctor makes more money not less.

The Post reported: "Doctors at the Charleston Cancer Center in South Carolina began informing patients weeks ago that, due to the sequester cuts, they would soon need to seek treatment elsewhere."

Doctors' advocacy groups are petitioning Congress to lower the amount that the sequester takes out of their payment. Of course if the Federal government wanted to, it could force the pharmaceutical corporations, Big Pharma, to lower prices or to negotiate prices, something that the Bush administration refused to do when they enacted Medicare Part D drug coverage.

So the doctors who can't do simple math (or maybe they can but are just trying to pull the wool over Congress' eyes) are lobbying Congress (who most certainly aren't capable of doing simple math) to come to their aid and increase the amount they get for administering a dose of a life saving cancer drug. The doctors are saying that the hospitals could possibly take on the patients they are rejecting, but we've already seen how hospitals are demanding upfront cash payments from patients so the chances of non-profit (although they make tons of profit) hospitals taking up the slack are about the same as a snowball's chances in hell.

April 06, 2013

America spends about $200 billion a year on prescription drugs. It's becoming part of American culture from preschool, where kids are started on Ritalin for ADHD, to old age where typical seniors are consuming an entire palette of pills for everthing from arthritis to high blood pressure to cholesterol. Drugs are the fastest growing part of the health care bill. In 2002 the average price for the fifty drugs most used by seniors was nearly $1500. for a year's supply. That's for each drug. Most seniors are taking an average of six.

Drug prices are highest for people who are the poorest. That's because they have no insurance, and, therefore, no bargaining power. Drugs are marketed extensively by means of TV ads. Those ads are usually followed by ads for law firms trolling for clients who have been harmed by said drugs.

Drug companies say that they must charge such high prices to pay for all the research and development they do to discover new wonder, lifesaving drugs. The truth is more prosaic. Drug companies' research budgets are dwarfed by their budgets for marketing, advertising and executive salaries. As in the hospital industry (which we discussed here, here, here and here), drug prices have little to do with production costs.

Most R&D for new drugs is performed by academic institutions or by the government at the National Institutes of Health. The vast majority of "new" drugs are not actually new but are slight modifications of old drugs designed in such a way as to extend the life of their patents and fend off encroachment by cheaper generic drugs. There are also the "me-too" drugs, slight variations by different drug companies in order to capture a share of the market. We now have six statins on the market to lower cholesterol all of which are variations of the first to be developed - Mevacor, Lipitor, Zocor, Pravachol, Lescol and Crestor. Such phony tributes to "free choice" are in reality a waste of resources whose sole purpose is to make money for Big Pharma.

Dr. Sharon Levine, associate executive director of Kaiser Permanente Medical Group put it this way: "If I'm a manufacturer and I can change one molecule and get another twenty years of patent rights, and convince physicians to prescibe and consumers to demand the next form of Prilosec, or weekly Prozac instead of daily Prozac, just as my patent expires, then why would I be spending money on a lot less certain endeavor, which is looking for brand-new drugs?" As a result little effort is put into finding effective flu drugs or new anti-biotics because there is little money in it.

An example of the encouragement of chemical dependency of the American people is the marketing of the chemically induced hard-on drugs such as Viagra, Cialis and Levitra. And from the pharmaceutical corporations point of view, it's not enough to condition American males to take a drug every time they have sex, but it was important to transition them to taking the drug on a daily basis so that they they will always "be ready when the moment is right". But Big Pharma's rationale is not hard to fathom - they want American males addicted and dependent on their pill in order to feel confidant enough to have sex. It's a billion dollar industry.

Generic drugs are drugs that are identical to brand name drugs and usually sell for a fraction of the price. They can be sold after patent protection on the brand name drug runs out - usually after 12 years. India is the leading manufacturer of generic drugs selling them to poorer, developing countries. For example, Thailand has imported millions of doses of a generic version of the blood-thinning drug, Plavix (used to help prevent heart attacks), at a cost of 3 US cents per dose, from India. A recent ruling by the Indian Supreme Court ensures that India will be able to continue to manufacture generic drugs and sell them to developing countries. Before it went generic in the US Plavix was costing consumers $200. a month or amost $7.00 a dose.

India exports about $10 billion worth of generic medicine every year. India and China together produce more than 80 percent of the active ingredients of all drugs used in the United States. So why should they adhere to US style patent protections when they are actually making the ingredients for the drugs which are not even manufactured in the US?

"Specifically, the decision allows Indian makers of generic drugs to continue making copycat versions of the drug Gleevec, which is made by Novartis. It is spelled Glivec in Europe and elsewhere. The drug provides such effective treatment for some forms of leukemia that the Food and Drug Administration approved the medicine in the United States in 2001 in record time. The ruling will also help India maintain its role as the world’s most important provider of inexpensive medicines, which is critical in the global fight against deadly diseases. Gleevec, for example, can cost as much as $70,000 a year, while Indian generic versions cost about $2,500 a year."

While India has been fighting to produce generic lifesaving drugs cheaply, Big Pharma, on the other hand, has been lobbying for the stricter patent protections (and hence higher profits) that they currently have in the US. The rest of the world is not buying it, fortunately. Now Big Pharma wants the US government itself to lobby other countries for stricter patent protection. And why not? Big Pharma gets its way in the US by lobbying Congress. It would just be an extension of the role of the US government to let itself be used as a lobbying tool with respect to other countries.

India is on to the fact that most US drugs under patent protection are slightly altered versions of previous drugs whose patent protection has run out. Sometimes only one molecule has been altered. India is not buying the fact that these drugs deserve patent protection. The US government though has bought this argument hook, line and sinker. That's why customers in the US pay through the nose for their prescription drugs.

Anand Grover, a lawyer who argued the case on behalf of Cancer Patients Aid Association in India, said that India would prefer to save lives rather than allow US corporations to make higher profits. “What is happening in the United States is that a lot of money is being wasted on new forms of old drugs,” Mr. Grover said. Because of the Indian Supreme Court ruling, “that will not happen in India.”

A majority of drug patents given in the United States are for tiny changes that often provide patients few meaningful benefits but allow drug companies to continue charging high prices for years beyond the original patent life. Take AstraZeneca, for example, which extended for years its franchise for the huge-selling heartburn pill Prilosec by slightly altering the chemical structure and renaming the medicine Nexium.

Other countries are wising up to the malignant policies of Big Pharma which maximizes its profits by having the ingredients for its high priced drugs made in Asian sweatshops while seeking to charge other countries the outrageous prices it charges its US customers under the veil that it needs to charge these prices in order to continue with research and development on new drugs. But the fact of the matter is that it does little research on new drugs; that is undertaken by academics and the US government. Big Pharma uses its money to advertise on TV and to try and get as many Americans as possible dependent on prescription drugs.

The real question is why US citizens should stand for paying high prices, that have nothing to do with manufacturing costs, to Big Pharma. In some cases these prices are totally extortionary. It's "your money or your life" for cancer drugs in particular. This maximization of profits for lifesaving drugs represents one of the worst excesses of capitalism. It represents one of the worst aspects of the capitalistic ethos that nothing will be or should be done to benefit mankind or society unless it is done for profit. That people will only be helped if there is a profit motive for doing so. This is what Ronald Reagan and Ayn Rand preached - that no good shall be done unless it is done for profit. This is totally contrary to the Christian ethic of helping those in need regardless of profit.

April 01, 2013

NEW DELHI — India’s Supreme Court rejected a Swiss drug maker’s patent application for a major cancer drug Monday in a landmark ruling that will permit poor patients continued access to many of the world’s best drugs, at least for a while.

The ruling allows Indian makers of generic drugs to continue making copycat versions of the Novartis drug Gleevec — also spelled Glivec in Europe and elsewhere — which provides such a miraculous cure for some forms of leukemia that the Food and Drug Administration approved the medicine in the United States in 2001 in record time.

But the ruling’s effect will be felt well beyond the limited number of leukemia patients in India who need Gleevec. On the one hand, it will help maintain India’s role as the world’s most important provider of cheap medicines, which is critical in the global fight against HIV/AIDS and other diseases. Gleevec can cost up $70,000 per year, while Indian generic versions cost about $2,500 year.

“India, being the pharmacy capital of the world, can continue to produce affordable, high-quality medicines without the threat of patents for minor modifications of known medicines,” Dr. Yusuf K. Hamied, chairman of Cipla, an Indian generic drug giant, wrote in an e-mail.

On the other hand, the ruling could cost lives in the future. Drug company executives and others argue that India’s failure to grant patents for critical medicines -- and Gleevec is widely recognized as one of the most important medical discoveries in decades – is a short-sighted strategy that undermines a vital system for funding new discoveries.

In a televised interview, Ranjit Shahani, vice chairman of Novartis’s Indian subsidiary, said that companies like Novartis will invest less money in research in India as a result of the ruling. “We hope that the ecosystem for intellectual property in the country improves,” he said.

The ruling is a landmark in one of the most important economic battles of the 21st century, in which rich nations that increasingly rely on the creation of idea-based products like computer programs and medicines require poorer countries to pay for their ideas. But some countries – particularly India, Brazil and China – have begun to challenge the price they must pay, particularly when the ideas-based products are life-saving medicines that their people desperately need now.

The question is how to pay for ideas in ways that maximize their use while encouraging their creation, two sometimes contradictory goals. Poor countries have tended to focus on the immediate issue of access while tending to ignore the more uncertain and far-off issue of innovation, particularly since innovation tends to occur far from their shores.

India exports about $10 billion worth of generic medicine every year, more than any other country. India and China together produce more than 80 percent of the active ingredients of all drugs used in the United States.

In Monday’s decision, India’s Supreme Court ruled that the patent that Novartis sought for Gleevec did not represent a true invention. The ruling is something of an historic anomaly. Passed under international pressure, India’s 2005 patent law for the first time allowed for patents on medicines – but only for drugs discovered after 1995. In 1993, Novartis patented a version of Gleevec that it later abandoned in development, but the Indian judges ruled that the early and later versions were not different enough for the later one to merit a separate patent.

Leena Menghaney, a patient advocate at Doctors Without Borders, said that the ruling is a reprieve from more expensive medicines, but only for a while.

“The great thing about this ruling is that we don’t have to worry about the drugs we’re currently using,” Ms. Menghaney said. “But the million-dollar question is what is going to happen for new drugs that have not yet come out.”

Anand Grover, a lawyer who argued the case on behalf of Cancer Patients Aid Association in India, said the ruling had a sweeping effect since it confirmed that India has a very high bar for approving patents on medicines.

“What is happening in the United States is that a lot of money is being wasted on new forms of old drugs,” Mr. Grover said. Because of Monday’s ruling, “that will not happen in India.”

Indeed, the vast majority of drug patents given in the United States are for tiny changes that often provide patients few meaningful benefits but allow drug companies to continue charging high prices for years beyond the original patent life.

In a classic example, AstraZeneca extended for years its franchise around the huge-selling heartburn pill, Prilosec, by performing a bit of chemical wizardry and renaming the medicine as Nexium. Amgen has won such a blizzard of patents on its hugely expensive erythropoietin-stimulating drugs that the company has maintained exclusive sales rights for 24 years, double the usual period.

One result is that the United States pays the highest drug prices in the world, prices that only a tiny fraction could afford in India, where more than two-thirds of the population lives on less than $2 a day. While advocates for the pharmaceutical industry argue that fairly liberal rules on patents spur innovation, academics are far from united in sharing that view.

But as the economies of emerging markets grow, their refusal to pay higher premiums for newer drugs could significantly reduce the money needed for innovation. The drug industry makes nearly two-thirds of its profits in the United States, a dependence that many in the industry fear is unsustainable. And even minor improvements in medicines – making a pill once-a-day instead of twice-a-day – can have significant impacts on patient wellness, industry executives say.

The United States government has become increasingly insistent in recent years that other countries adopt far more stringent patent protection rules, with the result that poorer patients often lose access to cheap generic copies of medicines when their governments undertake trade agreements with the United States.

Drug companies have relied on the American government to lobby on the issue because they have few tools to punish India and other countries. If the companies decide not to introduce high-priced drugs in India, the country could legalize generic copies under international law. And with major drug makers cutting back on research budgets anyway, large investments in research infrastructure may be unlikely even if countries adopt patent laws more amenable to the industry.

March 26, 2013

Hospital care in the US has morphed into a multi-headed monster in which every advance in medical technology ups the cost of medical care. What Matt Taibbi said about Goldman Sachs in a Rolling Stone article applies to hospitals as well: "[They are] a great vampire squid wrapped around the face of humanity, relentlessly jamming [their] blood funnel[s] into anything that smells like money." More expensive technologies like cat scans are used when less expensive ones would be adequate to do the job. In addition to the economic incentives to use more expensive technology and equipment, there's the legal incentive that doctors are less likely to be sued if they administer every test under the sun and use the most expensive equipment. Drugs that are administered to cancer patients can cost tens of thousands of dollars a shot.

The Chargemaster is a humungus computer file which details every charge that a hospital can add to a patient's bill from a lowly aspirin to heart surgery. A recent perusal of a Chargemaster for San Diego's Scripps Memorial Hospital revealed over 54,000 items. These charges are so far removed from actual costs to the hospitals (most of which are non-profits) that the US spends twice as much on health care as most other advanced nations - 20% of GDP compared to 10%. The non-profit hospitals take in more than they spend which is perfectly legal. They just can't distribute the profits to shareholders, but no problem with giving executives and administrators huge salaries. The US spent $2.7 trillion on health care in 2011.

For these reasons, Dr. Andrew Weil, Professor of Medicine and Public Health at the University of Arizona says, "We don't have a health care system in this country. We have a disease management system." 75% of healthcare costs go to treating chronic diseases that are largely preventable. Of course there's no money in helping patients prevent disease. The fee for service model guarantees that the money comes from treating and retreating and retreating disease, not from preventing it in the first place. Physicians routinely receive substantial compensation from medical-device companies through stock options, royalty agreements, consulting agreements, research grants and fellowships. According to Gregory Demske, assistant inspector general at the Department of Health and Human Services, "We found that during the years 2002 through 2006, four manufacturers, which controlled almost 75% of the hip-and-knee-replacement market, paid physician consultants over $800 million under the terms of roughly 6500 consulting agreements."

And as we showed in Part 2, having medical insurance is no panacea. 69% of those who've experienced medically related bankruptcy were insured at the time of their filing. 62% of all bankruptcies are related to illness or medical bills. 44% of low wage workers at small firms were uninsured in 2010.

Pharmaceutical corporations are some of the biggest profit makers in the health care system. The Medicare Prescription Drug Act (Medicare Part D) passed by President George W Bush was a huge giveaway to the drug companies. It forced Medicare to purchase drugs for seniors at full retail prices. It denied Medicare the power to negotiate drug prices which the Veterans' Administration can do. Instead Medicare simply has to determine the average sales price and add 6% to it. As a result Medicare's spending on cancer drugs ballooned from $3 billion in 1997 to $11 billion in 2004. Today the price for these drugs is more than $20 billion. Even though some drugs on the market may be cheaper and more effective, Medicare is required to pay retail for any drug a doctor orders providing that it has been approved by the FDA.

Dr. Peter Bach of Sloan-Kettering, frustrated by the rising cost of cancer drugs, declared in an op-ed in the New York Times that he would no longer administer a colorectal-cancer drug called Zaltrap which cost an average of $11,063.00 a month for treatment. His research showed that another drug, Avastin, which cost $5000.00 a month was just as effective. Typical new cancer drugs coming on the market have jumped in price from $4500.00 a decade ago to around $10,000.00 today. Two of the new cancer drugs cost more than $35,000.00 each per month of treatment. More and more the cost of these drugs is borne by the patients themselves. In such cases the rich will live and the poor will die.

Glaxo Smith Kline developed a diabetes drug called Avandia. By 2006 Avandia, which had been massively marketed, became the largest selling diabetes drug in the world. It was a $3 or $4 billion a year drug. Dr. Steven Nissen found in checking the literature for clinical trials that there was about a 30% greater risk of a heart attack for those patients using Avandia. It made him physically ill. He said that "when medicine became a business, we lost our moral compass." After pointing this out, the company did nothing. Avandia was too much of a moneymaker. They told no one. They did not tell physicians. They did not tell the FDA.

"Having a diabetes drug that increases the risk of heart attack by nearly one third is a public health catastrophe, and the company didn't tell anybody," Dr. Nissen said. Finally, the FDA put severe restrictions on the drug. The company set aside $6 billion to settle lawsuits. The FDA estimated that somewhere between 50,000 and 200,000 deaths were attributable to Avandia. In July 2012 GSK agreed to plead guilty for failing to disclose safety data on Avandia as part of a $3 billion settlement.

Add Celebrex and Vioxx to the list of highly advertised drugs like Avandia that cause increased risk of heart attack and stroke. These drugs are used by arthritis sufferers to relieve pain. But Merck continued to market Vioxx even after they knew the drug was not safe. Today Merck faces not only Congressional and Justice Department investigations, but also potentially thousands of personal-injury lawsuits that could tie the company up in litigation for years and possibly cost it billions. In addition to heart attack and stroke these drugs cause serious gastrointestinal bleeding.

The importance of Celebrex to Pfizer is indisputable. It is one of the company’s best-selling drugs, racking up more than $2.5 billion in sales, and was prescribed to 2.4 million patients in the United States last year alone. Although Vioxx was taken off the market in 2004, Celebrex is still being marketed even though Pfizer withheld crucial data regarding the drug's safety. They wagered that profit concerns overrode liability concerns. First, they compute the product's profit potential and weigh that against the projected liabilities. If the former exceed the latter, they continue to sell. Their corporate duty after all is to maximize profits to shareholders, not to protect the well being of customers.

Flebogamma is a cancer drug, made from human plasma, that is intended to boost the immune system. Sloan-Kettering buys it from a Spanish company called Grifols. A typical dose was bought from Grifols for about $1500.00 but they charged Medicare $2135.00. In most of the developed world there are tight controls on profit margins that drug companies can make. Not so in the US. In fact prescription drug prices in the US are 50% higher for comparable products than in the rest of the developed world. More than $280 billion will be spent this year in the US on prescription drugs. If we paid what other countries pay, we would save $94 billion a year.

Republicans want to reduce the cost of entitlements like Medicare. But they totally ignore the fact that they themselves made it illegal for Medicare to negotiate drug prices which would save Medicare tons of money. Here's where they need to start in reforming Medicare. They could pass legislation overnight to do it, but they won't because the truth is that they are not so much interested in reducing the cost of Medicare as they are in increasing the profits of the drug industry and using the high cost of Medicare as an excuse for cutting benefits or getting rid of Medicare altogether. Their idea of "reform" is to cut benefits rather than cutting corporate profits. They intend to cash in and make their own big money by becoming lobbyists for the health care industry after their "public service" (er, uh disservice) ends. 80% of Congressmen go on to become lobbyists.

In Part 2 we reported on a cancer patient by the name of Sean Recchi who was told that he had to pay his $83,900.00 bill upfront and in cash because the hospital wouldn't take his "discount insurance." Recchi was administered 660 mg of a cancer wonder drug called Rituxan. He was charged $13,702.00. The hospital, MD Anderson, probably paid around $3000.00 for the drug making the markup for Recchi's lifesaving shot about 400%.

The motto for the drug industry might as well be "Your money or your life." Americans spent $307.4 billion on prescription drugs in 2010. Marcia Angell, MD, former editor of the New England Journal of Medicine writes in "The Truth About the Drug Companies," subtitled "How They Deceive Us And What We Can Do About It": "Now primarily a marketing machine to sell drugs of dubious benefit, the [drug] industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the Food and Drug Administration, academic medical centers, and the medical profession itself." No wonder then that more people today die from legal prescription drugs than from illegal drugs.

On a personal note, I went to a dermatologist a few years ago with a skin rash. He prescribed a product called Taclonex. When told at the pharmacy that a 60 mg tube of Taclonex would cost $600., I went on the internet and got the same product from a Canadian pharmacy for $100.

Even though we spend more on health care than other countries, we have worse outccomes. Life expectancy in the US is not even in the top 20. In fact we're behind Jordan, Greece, the Virgin Islands, Puerto Rico, Bosnia and Herzegovina and Portugal coming in at a rank of 50.

Shannon Brownlee, a medical journalist says "We have a disease care system. We have a very profitable disease care system." It's a system that "doesn't want you to die and it doesn't want you to get well." In either case that would kill the cash cow which fee for service medicine provides. "It just wants you to keep coming back for your care of your chronic disease."

March 19, 2013

Hospitals mark up the cost of over the counter supplies like aspirin and Q-tips as much as 1000%

Hospitals charge their customers ... er, patients, through the nose for simple products which anyone can purchase at WalMart for a fraction of the amount. In Part 1 and Part 2 we detailed the ridiculous prices hospitals routinely charge their patients - like several thousand dollars a day - just for a room. In this installment we will go over the markups on products that are added on to patients' bills. Suffice it to say that for anything consumable, there will be a Chargemaster billing item. The Chargemaster is the giant computer file that lists the charge for every possible medical service and supply that a hospital provides. Nothing is "included." Everything is billed out separately, ala carte. The following outlandish charges are referenced in a Time article, Bitter Pill: Why Medical Bills Are Killing Us, by Steven Brill.

Like, for example, gauze pads. Following a patient's diagnosis of lung cancer, he was charged $308.00 for four boxes of sterile gauze pads each containing twenty-four 4 inch by 4 inch dressings, which can be bought over the counter at Walgreen's for $3.99 a box. These were tacked onto his $348,000.00 bill. Another patient was charged $18.00 each for Accu-Chek diabetes test strips. Amazon sells boxes of 50 for about $27.00 or 55 cents each. For the price of one Lipitor pill in the US you can buy three in Argentina. One hospital charged $1.50 for one 325-mg acetaminophen tablet. You can buy 100 tablets on Amazon for $1.49. That's a 10,000% markup.

One Nexium pill in the US costs the same as eight of them in France. No wonder the pharmaceutical industry has millions of dollars to spend on TV advertising to try to convince you to talk your doctor into prescribing them for you. Then as soon as you see the ad to get you to buy Plavix, there follows an ad for some legal firm saying in effect "If you've ever been harmed by Plavix, call the Dewey, Cheatham and Howe law firm." For instance, the lawyers at Saiontz & Kirk, P.A. are trolling for Plavix users throughout the United States who have suffered serious and potentially fatal injuries as a result of the medication. Their website states: "Research has linked side effects of Plavix to an increased risk of certain health problems, which the manufacturer failed to adequately warn about."

Steven H's bill contained an item - MARKER SKIN REG TIP RULER - for $3.00. That's the reusable marking pen that marked the place on Steven H's back where the incision would go. Then there was the STRAP OR TABLE 8X27 IN for $31.00 That's the strap used to hold Steven H onto the operating table. Hey, do you suppose they could use that again for some other patient? Right after that charge was one for $32.00 for a BLNKT WARM UPPER BDY 42268. That's a blanket whose purpose is to keep surgery patients warm. It is of course reusable and is available on eBay for $13.00 They even billed poor old Steven H for the gown the surgeon wore! That came to $39.00 You can buy thirty of them online for $180.00

On one patient's bill was a charge of $108.00 for Bacitracin a common antibiotic ointment which can be purchased over the counter at Walgreen's for $5.99. But a charge on Sean Recchi's bill takes the cake. We detailed Sean Recchi's case in Part 2. As part of his $83,900.00 bill (that he was ordered to pay in advance of any treatment and in cash) was a charge of $7.00 each for an ALCOHOL PREP PAD. This is a little square of cotton used to apply alcohol to an injection. A box of 200 can be bought online for $1.91. These kinds of charges show just how picayune the charges dictated by the Chargemaster can be. And remember these are non-profit hospitals, non-profits that make huge profits, more than most for-profits because - guess why - they don't pay any taxes.

Soon after his diagnosis of lung cancer, Steven D and his wife knew that they were just in the business of buying time. And because of that the Chargemaster money demanded by the health care system went into overdrive. It reached a whole different and exalted plateau. By the time Steven D died 11 months later in his Daly City, California home, his bills totaled $902,452.00. It was left for his surviving wife, who made about $40K a year running a child-care center, to pay it off. The first bill from Seton Medical Center for $348,000.00 was full of Chargemaster profit grabs. For instance, there was a charge of $24.00 each for 19 niacin pills that are sold in drugstores for about a nickel apiece.

Steven D and his wife maxed out on a UnitedHealthcare policy for $50,000. that he had bought through a community college where Steven was briefly enrolled. We detailed the destructive effects of these mini-med, limited benefit policies in Part 2. That left them with over $850,000.00 for which they themselves were responsible. Luckily, they found a billing advocate who negotiated their bill down to what amounted to an 85% discount. When Steven Brill contacted Seton Medical center to ask why there were all these ridiculous charges that they were subsequently willing to negotiate down if the patient's family was lucky enough to find a billing advocate, there was no comment. There was no comment either to the question of why they sent patients' families bills that they didn't expect to collect at a particularly sensitive and upsetting time in their lives. When all was said and done, Steven D's wife said: "I'm never going to remarry. I can't risk the liability."

When Brill queried Texas Southwestern Medical Center about a patient's charge of $132,303.00 for LABORATORY, which included hundreds of blood and urine tests that ranged from $30.00 to $333.00 each, he was told that no one was available to discuss billing practices. A hospital spokesman informed him, "The law does not allow us to talk about how we bill." Really? It's against the law to discuss the bill? Who knew? If, however, this unfortunate family had been on Medicare, Medicare would have paid Texas Southwestern either nothing or $7.00 to $30.00 for these tests because Medicare negotiates prices with hospitals based on the real cost of the service or item, not on some out-of-touch-with-reality fantasy cost like those dictated by Chargemaster.

Most hospitals overorder lab tests especially for those patients staying multiple days. Every day new tests are ordered even though they're not necessary. They become a cash cow for the hospital. And it's a cash cow for the many doctors who stroll around poking their heads into various patients' rooms. It gives them something to talk about and an excuse for charging big sums for every poke. One ingenuous doctor told Brill, "I bet 60% of the labs are unnecessary." Doctors cruise the halls and pop in their heads wherever while collecting handsome fees.

How do hospitals get away with it? Lobbying is the answer, pure and simple. For every member of Congress, there are more than seven lobbyists working for various parts of the health care industry. The health care industry, what I call the medical-industrial complex, has spent $5.36 billion since 1998 lobbying in Washington. That is even larger than the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by the oil and gas corporations over the same period. The medical-industrial complex spends three times more than the military-industrial complex lobbying Congress which consists of politicians who are supposed to be representing We the People but in fact are representing the health care industry.

March 09, 2013

In Part 1 we told about how hospitals have a huge computer file called a Chargemaster that details prices for every possible item a hospital can charge for. These prices don't have anything to do with reality because in fact there is no market for health care services. In a truly capitalist economy there would be a competitive market by means of which people could check prices and choose the service that's the most reasonable in terms of price and other factors. It's called price discovery. Hospital charges represent a dark market just like over the counter derivatives because it's next to impossible to get hospitals to reveal their prices for any of their services. According to an extensive article in Time, the author was given the brushoff and even told it was illegal every time he tried to get pricing information. Therefore, the Chargemaster details prices that are sky high and out of sight compared to the paying abilities of most Americans.

In Part 2 we will cover the plight of many folks who thought they had sufficient health insurance coverage only to be told that their insurance policies were useless and they would be required to pay cash upfront if they wanted to access hospital services. Take the case of Sean and Stephanie Recchi, for example. They had purchased for $469. a month a policy that covered $2000. a day of any hospital costs. When Sean, age 42, was diagnosed with non-Hodgkin's lymphoma, he needed immediate cancer treatment, and so they called for an appointment at MD Anderson Cancer Center in Houston, Texas. They were told by the person on the other end of the line, "We don't take that kind of discount insurance," and that they would have to pay $48,900. in cash in advance just to be examined for six days so a treatment plan could be devised. Luckily, Stephanie's mother had the wherewithal to write the check.

The doctors diagnosed Sean's condition as making immediate treatment necessary. He had a large mass in his chest that was growing and his condition was deteriorating. However, treatment could not be begun until the Recchis wrote out another check for $35,000. But even this didn't satisfy the doctors at MD Anderson Cancer Clinic. They were going to make Sean Recchi wait until the check had cleared. Only after they advanced the hospital $7500. on Sean's credit card did they start treatment. The total costs for Sean's treatment plan and to begin his chemotherapy came to $83,900. which the hospital wanted up front... in cash! God help the poor slob who couldn't come up with the money! Here's the truth about the American health care system: the rich will live and the poor will die. As Billie Holiday sang: "God bless the child who's got his own."

The kind of insurance the Recchis had was a coverage plan commonly called a mini-med. They are widely sold as an alternative to expensive comprehensive care. The premiums are more affordable but the catch is that the benefits are limited. Those limitations might seem reasonable to most people, but they have no idea what hospitals are charging nowadays for even the most basic items. Chargemaster prices defy any rational assessment. These policies target the self-employed like the Recchis and cover very little when it comes right down to it in the health care world of exhorbitant charges. They are also targeted at employers in industries such as retail, temporary staffing agencies and food service who want to show that they have a little something extra to offer employees while in fact what they have to offer is virtually worthless.

In 2010 the Los Angeles City Attorney's office filed a suit on behalf of the people of California against a company called HealthMarkets Inc and its Wall Street owners saying the policies were just junk. The Wall Street owners were none other than our old friends, Goldman Sachs and private equity fund Blackstone Group founded by Peter G Peterson and Stephen A Schwarzman. The suit alleged that Goldman and Blackstone knew about the health insurance scams when they bought a majority stake in the company in 2006. They also controlled the Board. An LA Times article stated:

"The city attorney's suit, based on state laws for unfair competition and false advertising, accuses the defendants of engaging in a "scheme to defraud California consumers … through the sale of junk insurance," which it defined as coverage that has "hidden or obscure" terms.

"All their marketing and training and advertising was aimed at convincing people that this was comprehensive coverage that will protect you in your time of need. It certainly did not prove to be that way," Chief Assistant City Atty. Jeffrey Isaacs said."

And then there was the case of the Woffindens. Their agent assured them that they would have catastrophic coverage the same as their prior Blue Cross coverage which they had lost when the company Howard Woffinden worked for went out of business. But some time after they bought the policy Charlotte Woffinden became seriously ill. The Woffindens were told that their policy wouldn't cover an expensive test she needed. So Howard wrote the hospital a check for $6,500. Then although Howard knew that there was a $5000. deductible on the policy, which he thought was an annual deductible, it turned out that it was a $5000. deductible per occurence. Charlotte's illness turned out to be cancer and she would need expensive surgery and chemotherapy. They were told by Cedars Sinai hospital that their insurance policy was virtually useless. It wasn't worth the paper it was written on. According to a Dan Rather report, the Woffindens were greeted by a Cedars Sinai admissions agent who informed them that their policy didn't even cover one day in the hospital, and asked how they were going to pay the bill. They were told they couldn't be admitted with such a policy.

Cedars Sinai eventually agreed to admit Charlotte, but she wouldn't be given certain expensive therapies. She died at home four months later knowing that they owed more than $700,000. in medical bills and believing that her family was financially ruined. A former agent for HealthMarkets, Eric Dyer, outed the deception that HealthMarkets encouraged its agents to practice. They were encouraged to give the impression that what they were selling was Major Medical when in fact it wasn't. What the Woffindens bought was not Major Medical which they had had with Blue Cross but a specified limits or limited benefits plan although the premiums were about the same so they assumed the coverages were similar. For example, Woffindens' HealthMarkets policy stated that it would cover the cost of a room at the hospital up to $300. a day. However, the average cost for a room at a hospital in the LA area was around $4000. a day. The HealthMarkets policy claimed it would cover the cost of chemotherapy 100% up to $1000. a day. One day of chemo actually cost the Woffindens $14,000.

Howard Woffinden and many others have sued and settled with HealthMarkets. Two state attorneys general have gone after them as well. A deputy city attorney in LA has disclosed that his office is also going after HealthMarkets owners, Goldman Sachs and Blackstone. These Wall Streeters have made over $200 million in dividend payments to them from HealthMarkets. Since they are directly involved in HealthMarkets and are not passive investors, the LA city attorney's office thinks they should also be named as defendants in the lawsuit.

If you go over Sean Recchi's hospital bill line by line, you come up with some fascinating information. Every time a nurse drew blood, there was a $36.00 charge accompanied by a dozen or more charges ranging from $23. to $78. for lab analyses performed on the blood sample. In all, the charges for blood tests on Recchi were more than $15,000. If he had been old enough for Medicare, Medicare would have paid a few hundred dollars for all those tests because Medicare negotiates prices based on actual costs not pie in the sky, detached-from-reality Chargemaster insanity. Recchi was charged $13,702 for one injection of the so-called wonder drug, Rituxan. The average price paid by all hospitals for this drug is $4000., but MD Anderson probably pays more like $3000. because of a volume discount. That means that the non-profit cancer center's markup for which Recchi had to pay upfront was about 400%.

Non-profit MD Anderson knows how to charge in return for its lifesaving cancer therapies. Its operating profit for 2010 was $531 million based on revenues of $2.05 billion. That's a profit margin of 26%! MD Anderson's President, Ronald DePinho, was paid last year $1,845,000. That does not count money made from his ties with three pharmaceutical companies. That salary is triple that paid to the president of the entire University of Texas system of which MD Anderson is only a part. This is typical of university systems in the US where the president of a hospital associated with the university is paid more than the university president him or herself. (Mainly, "him", I think.)

The American health care market has transformed tax-exempt "nonprofit" hospitals into many towns' most profitable businesses and largest employers. And the system offers lavish paychecks even to mid-level hospital administrators. 14 administrators at New York City's Memorial Sloan-Kettering Cancer Center are paid over $500,000. a year including six who make over $1 million.

The advance of medical technology and wonder drugs, while praised by some as forging ahead and creating a better future for American health care, only result, to my way of thinking, in the addition of huge costs over what we would have had to pay for less technologically sophisticated apparati and procedures without producing appreciatively better results. This drives the costs of health care so that we Americans pay 20% of GDP on health care while the rest of the world spends closer to 10%. Yet our health care results are no better and often worse than those in countries that spend a fraction of what we do on health care.

March 08, 2013

A recent exhaustive article in Time magazine details the exhorbitant charges that hospitals are imposing on the American people, charges that have nothing to do with the actual costs of services provided. A woman in Stamford, Connecticut suffering from chest pains called 911. She was taken by ambulance to the emergency room at Stamford Hospital, a non-profit institution, four miles away. After a few hours of tests she was told that she just had a case of indigestion; her heart was fine. So she went home. Her bill: $21,000 - for a false alarm. That breaks down to $995. for the ambulance ride, $3000. for the doctors and $17,000. for the hospital. Unfortunately, she had no insurance because she had been out of work for a year.

The American medical marketplace is such that those least able to pay are charged the most money. Their prices are determined by what is called a Chargemaster, a massive computer file thousands of items long. Every hospital has one. The prices for medical services detailed in the Chargemaster have nothing to do with reality but are arrived at totally arbitrarily because there is no competition in the medical marketplace. And if you ever tried to find out in advance what the cost of some medical service was, you'd most likely be given the brushoff and told that it would be illegal for the hospital to tell you.

I had an experience like this myself. A few years ago, my family doctor advised me to get a colonoscopy and referred me to a gastroenterologist. Let's call him Dr. Goldfacher (not his real name). On the initial appointment, his receptionist presented me with a sheaf of papers to sign basically holding Dr. Goldfacher blameless no matter how badly he botched up the procedure. I told her that, before I signed those papers, I wanted to know the total cost of the procedure including pre-op and post-op office visits, the doctor's charge, the hospital's charge etc. Of course, she didn't know, but after some back and forth she said someone else would be sent out to help me. After a while a young man appeared, gave me a long spiel as to why the information I wanted to know was irrelevant, and, by way of a punch line, told me that it would be illegal for Dr. Goldfacher to tell me how much all of this would cost. I walked out of the office without signing away my rights. Last year under Obamacare I got a "free" colonoscopy with another doctor. However, although the colonoscopy was free there were numerous ancillary charges involved so that in the final analysis one could say it wasn't exactly free, but it was reasonable.

The woman from Stamford who thought she was having a heart attack was 64 years old, not yet eligible for Medicare. If she had been on Medicare, her bill would have been a small fraction of what she was actually charged by the Chargemaster and most of it would have been paid by Medicare. Medicare Part A covers 100% of hospital costs, and Medicare Part B, for which the recipient pays approximately $100. a month usually taken out of the recipient's social security check, pays 80% of doctors' fees. The Medicare enrollee can buy what is known as Medicare supplementary insurance from a private insurance company to cover the other 20%. Medicare mandates that hospitals charge it according to their actual costs i.e. not the Chargemaster rates! The theory is that, since virtually all of these hospitals are set up as non-profits, each fee for service should reflect the actual costs sans profit. For example the woman in Stamford was charged $199.50 each for three troponin tests. Medicare would have paid the Stamford Hospital $13.94 each. She was charged $157.61 for a CBC test. Medicare would have paid $11.02.

The author of the study, Steven Brill, asserts that, for all the complaints about Medicare as "entitlement spending", Medicare is the only rational system that is holding down the cost of medical care in the USA. Without it medical costs, as dictated by the completely arbitrary and divorced from reality Chargemaster, would skyrocket. He goes as far as to maintain that far from restricting Medicare or raising the age that Medicare becomes available, the age for Medicare eligibility should actually be lowered. This would do more for keeping medical costs down than anything else. Thom Hartmann has called for Medicare Part E - Medicare available for anyone that wants to use it. But the medical-industrial complex has serious lobbying efforts going on to maintain the status quo. All of these non-profit hospitals like making exhorbitant profits. They just use the money to pay their administrators extravagant salaries so that the organization as a whole doesn't make a profit. Or they embark on huge building projects to soak up all that loose cash. What they don't do is to lower their prices.

According to a study by the consulting firm, McKinsey & Co., 2900 nonprofit hospitals across the country, which are exempt from income taxes, have higher profit margins than the 1000 for-profit hospitals that they studied after income tax obligations were deducted. Take the case of Mercy Hospital which is owned by an organization under the umbrella of the Catholic Church called Sisters of Mercy. As a tax-exempt charity it is dedicated "to carry out the healing ministry of Jesus by promoting health and wellness." Sisters of Mercy has a chain of hospitals across the midwest. According to income tax returns Mercy paid its top executive, president and CEO Lynn Britton, $1,930,000. in 2011 and an executive vice president, Myra Aubuchon, $3.7 million. (Why a vice president was paid more than the president, the article does not say.) All in all seven Mercy Health executives were paid more than $1 million each. At the same time, this charitable institution provided 3.2% of revenues for charity care based on Chargemaster prices. Based on Mercy's actual costs it probably provided about three-tenths of 1% of its revenues for charitable purposes.

The US spends more on health care than the next 10 big spenders combined: Japan, Germany, France, China, UK, Italy, Canada, Brazil, Spain and Australia. The price tag for Hurricane Sandy was $60 billion, part of which may not now be paid due to the sequester, but we spend almost $60 billion every week on health care. We spend more on artificial knees and hips every year than Hollywood collects at the box office. We spend two or three times that amount on canes and wheelchairs because the medical-industrial complex lobbies Congress and forces Medicare to pay as much as 75% more for this equipment than it would cost at Walmart. One hospital charged $1.50 for one 325-mg acetaminophen tablet, more than what Walmart charges for a hundred of them!

And lets not forget one of the biggest cost drivers of Medicare: George W Bush's prescription drug benefit which forced Medicare to pay Chargemaster like prices for drugs instead of negotiating those prices down like the Veterans' Administration does. You want to bring down the spending on Medicare which is miniscule compared to Chargemaster prices? Congress needs only to change the prescription drug benefit law and allow Medicare to negotiate with the drug companies.

September 19, 2012

David Cay Johnston’s up-to-date comparison of Europe’s health care costs vs. the US is another shocking revelation of how our country still struggles to have a sane, affordable basic health care system. He shows that the average per capita cost for health care in the U.S. is 2.64 times that of the average Organization for Economic Cooperation and Development (OECD) country cost per capita. In other words, for every $1 dollar of OECD personal healthcare cost, the US cost is $2.64.

In an extensive joint 2009 study (Health Care in the Netherlands and the US: A Comparative Study) comparing Dutch and US health care costs for a family of 4, we came up withalmost exactly the same ratio of a US cost of $2.40 for each $1 of Dutch cost for a family plan. To further document the startling cost differences Mr. Johnston has so well illustrated, following is a much abridged and edited version of our 2009 study. ________________________________________________________________________________________________________________________________________________________

PREFACE

By Frank Thomas and John Lawrence - December 7, 2009

The US has been consummately slow to learn from other countries that have systematically adopted transparent, standard basic health care that contain health care spending at 10% of GDP. However, US health insurance corporations with their myriad of non-standard policies continue to discriminate based on pre-existing conditions and to discontinue policies or raise premiums of those unfortunate enough to get sick. The Affordable Care Act popularly known as Obamacare, while not offering a public option, was, however, successful in eliminating pre-existing conditions and insurance firms' greedy ad hoc practice of cancelling policies or raising premiums of claimants judged sick too often.

We have chosen to compare in detail the US and the Netherlands' health care systems based on a family of four. It's important to point out that in both countries the health insurance systems are completely privatized. However, the two systems have produced diametrically opposite results. On a macroeconomic look, total health care spending in the Netherlands was 10.2% of GDP vs. approximately 17% for the US in 2009. Further, although the US has among the highest health care costs in the world, it ranks 37th in terms of outcomes. On a microeconomic look, both countries offer private health care via insurers … but Dutch health care providers compete on quality and service under a required basic health care system of "regulated competition" where the government has final oversight over premium prices, deductibles, costs and quality.

The following explanation puts all the detailed Dutch/US data in a "Big Picture" perspective. Figures for both countries exclude dental, except dental for children under 18 which is standard under the Dutch basic family plan. This in itself is an important bonus for the Dutch plan as US dental costs continue to soar. The Dutch plan includes something called "own risk" which simply means that people have the option of increasing the deductible by the amount of "own risk" in return for lower monthly premiums.

EXPLANATION

Key concluding observations are:

The average US family plan total cost for 4 is $16,530 or 2.4 times that of the Dutch basic family total cost of $6,913.

The Dutch basic plan comprises a standard comprehensive benefits package everyone purchases; the US plan is an average of a myriad of plans all with different non-standard benefit coverages.

The Dutch basic plan own risk ($495) plus deductible ($600) is $1,095 vs. a wide range of US family plan deductibles from $1,000 to over $4,000.

The Dutch basic family plan includes an employee tax contribution of $1,768. This relates to a 9.35% maximum wage tax on 50% of employee’s annual basic plan premium paid by the employer.

Employer and employee split a 7.2% tax on wages up to a maximum of $45,000. This goes into an equalization fund used to compensate insurance firms for documented "high risk" insurees. It’s also used to subsidize low-income people and those who are poor with little or no income.

The US very high absolute employer share of up to 74% of an outrageously high premium cost of $13,375 for a family of four – vs. 50% of a far lower premium cost of $3,174 under the Dutch basic plan – may explain partly why the US middle class wages have risen a miniscule 12% of inflation adjusted over the last 31 years! Employers are apparently treating their very high health care contribution as a wage benefit, substituting for a normal wage increase.

About 90% of the Dutch basic plan insurance for 16.5 million citizens is offered by six insurers. This provides a well-balanced actuarial risk pool of age/income/healthiness groups within an approximate 2.7 million average individual client base per insurer. Also, the Dutch regulated competition system is aimed at getting premiums/costs at affordable levels by a standard basic comprehensive benefits package required by all citizens. A competition regulator checks for any abuses of dominant market positions and creation ofcartels.An insurance regulator makes sure all basic plan policies have identical coverage provisions.

All the above gives economies of scale, easier assessment and comparison of best and worst practices by health providers. Its success depends on government’s enforcement of the rules governing premiums, costs, benefit coverage and, most importantly, quality.

Dutch medical procedures, prescription drug costs, prices, and coding of medical services are uniform throughout the country for the basic plan. This compares to the relatively complex, non-transparent, vast cost/price variations including non-uniform coding of medical services state to state for US family plans – all making best and worst practice comparisons almost impossible.

Unlike the US, copays, cost sharing or reimbursement limits on selected claims do not exist under the Dutch basic health care plan. Insurer and insured costs can be changed by the government increasing the ‘mandatory’ deductable (now at $275) or by the insured choosing for a higher ‘own risk-deductible in exchange for a lower health insurance premium.

Source: US data published by Kaiser Foundation in 2009(a) Includes $1,095 own risk/deductible for 2 adults (b) Includes $1,000 deductible for 2 adults(c) Includes $2,155 for coinsurance for 2 adults(d) +$1,768 Dutch taxes; No US federal or state taxes assumed(e) 50% for Dutch employer; ±70% for US employer

NOTE:US Plan figures from Kaiser 2009 study are an average of hundreds of non-standard plans. We have added a provision for coinsurance of $2,155. Copays, cost sharing or reimbursement limits on certain claims, and/or much higher deductibles are other typical features of US Plans. Also, many US Plans don’t offer 100% benefit coverage as does the Dutch Plan. The Dutch Plan has no coinsurance. Copays for doctor visits are netted against the own risk/deductible sum.

CURRENT SITUATION IN THE NETHERLANDS

In the Netherlands people are free to pay for more services over and above their basic plan coverage. There is no limit to the health care insurance plans that wealthy people can procure. At the same time everyone is covered by at least the basic plan, but no one is restricted to just the basic plan.

Like all advanced nations, the Netherlands is now faced with serious decisions on how to adjust their basic regulated market health care system in the face of a sharp increase in size of the older generation. This generation is also facing more costly high tech cures. This means sensible adjustments in own risk/deductibles, health sickness prevention, limits or changes in benefit coverage and strict discipline on insuring system efficiency and a sound financial balance … while continuing to provide one of the top best, affordable health care systems in the world. The challenges and changes are not easy by any stretch of the imagination … but IFrank is confident solid Dutch coalition governance will continue to pragmatically, creatively, and humanely master the hard health care cost/quality tradeoff realities.

One thing is certain – the Dutch are not about to allow their egalitarian, quality basic health care for-all-approach to be sacrificed to greedy insurer self-interests such as obscene management bonuses, profits and stockholder values FIRST and affordable, quality health care needs of claimants SECOND … as occurs under the currently costly, chaotic US private health care system.

In the US, Mitt Romney and Paul Ryan are promising to get rid of Obamacare on Day 1 if they should be elected to office. This would mean the continuation of sky-high premiums and insurance industry profits at the expense of the poor and lower income groups. It may also mean the possibility of being kicked off policies if people get too sick or of being denied insurance in the first place because of pre-existing conditions.

Adding oil to the fire, the “new” Ryan-Wyden Medicare reforms offer the option of retaining the traditional ‘fee-for-service’ government payments under Medicare or the option of receiving ‘voucher’ payments (mysteriously called ‘premium support’ payments by Ryan) to buy private insurance health care plans. The Ryan plan payment would be pegged to the lower end of health care premiums rather than to actual costs. Thus, people face the risk of ending up paying too much because of inflation.

Under these two payment options, the amount the government pays remains the same. Ryan’s plan has a spending growth cap per capita that must not exceed GDP annual % growth plus 0.5%. The CBO concludes this will reduce Medicare spending 35% to 45% by 2050 – leading to some negative results such as higher out-of-pocket costs, reduced access to health care, less quality of care, and reduced investment in advanced medical technologies. Caps would certainly disproportionately affect vulnerable groups when GDP growth rates are stagnant, especially for long-lasting recessionary periods … like now.

September 15, 2012

I first heard about a new Stanford "study" downplaying the value of organics when this blog headline cried out from my inbox: "Expensive organic food isn't healthier and no safer than produce grown with pesticides, finds biggest study of its kind."

What?

Does the actual study say this?

No, but authors of the study -- "Are Organic Foods Safer or Healthier Than Conventional Alternatives? A Systematic Review" -- surely are responsible for its misinterpretation and more. Their study actually reports that ¨Consumption of organic foods may reduce exposure to pesticide residues and antibiotic-resistant bacteria."

In any case, the Stanford report's unorthodox measure "makes little practical or clinical sense," notes Charles Benbrook -- formerly Executive Director, Board on Agriculture of the National Academy of Sciences: What people "should be concerned about [is]... not just the number of [pesticide] residues they are exposed to" but the "health risk they face." Benbrook notes "a 94% reduction in health risk" from pesticides when eating organic foods.

Assessing pesticide-driven health risks weighs the toxicity of the particular pesticide. For example the widely-used pesticide atrazine, banned in Europe, is known to be "a risk factor in endocrine disruption in wildlife and reproductive cancers in laboratory rodents and humans."

"Very few studies" included by the Stanford researchers, notes Benbrook, "are designed or conducted in a way that could isolate the impact or contribution of a switch to organic food from the many other factors that influence a given individual's health." They "would be very expensive, and to date, none have been carried out in the U.S." [emphasis added].

In other words, simple prudence should have prevented these scientists from using "evidence" not designed to capture what they wanted to know.

Moreover, buried in the Stanford study is this all-critical fact: It includes no long-term studies of people consuming organic compared to chemically produced food: The studies included ranged from just two days to two years. Yet, it is well established that chemical exposure often takes decades to show up, for example, in cancer or neurological disorders.

Consider these studies not included: The New York Times notes three 2011 studies by scientists at Columbia University, the University of California, Berkeley, and Mount Sinai Hospital in Manhattan that studied pregnant women exposed to higher amounts of an organophosphate pesticide. Once their children reached elementary school they "had, on average, I.Q.'s several points lower than those of their peers."

Thus, it is reprehensible for the authors of this overview to even leave open to possible interpretation that their compilation of short-term studies can determine anything about the human-health impact of pesticides.

What also disturbs me is that neither in their journal article nor in media interviews do the Stanford authors suggest that concern about "safer and healthier" might extend beyond consumers to the people who grow our food. They have health concerns, too!

Many choose organic to decrease chemicals in food production because of the horrific consequences farm workers and farmers suffer from pesticide exposure. U.S. farming communities are shown to be afflicted with, for example, higher rates of: "leukemia, non-Hodgkin lymphoma, multiple myeloma, and soft tissue sarcoma" -- in addition to skin, lip, stomach, brain and prostate cancers," reports the National Cancer Institute. And, at a global level, "an estimated 3 million acute pesticide poisonings occur worldwide each year," reports the World Health Organization. Another health hazard of pesticides, not hinted at in the report, comes from water contamination by pesticides. They have made the water supply for 4.3 million Americans unsafe for drinking.

Finally, are organic foods more nutritious?

In their report, Crystal Smith-Spangler, MD, and co-authors say only that "published literature lacks strong evidence that organic foods are significantly more nutritious than conventional foods." Yet, the most comprehensive meta-analysis comparing organic and non-organic, led by scientist Kirsten Brandt, a Scientist at the Human Nutrition Research Center at the UK's Newcastle University found organic fruits and vegetables, to have on "average 12% higher nutrient levels."

Bottom line for me? What we do know is that the rates of critical illnesses, many food-related --from allergies to Crohn's Disease -- are spiking and no one knows why. What we do know is that pesticide poisoning is real and lethal -- and not just for humans. In such a world is it not the height of irresponsibility to downplay the risks of exposure to known toxins?

Rachel Carson would be crying. Or, I hope, shouting until -- finally -- we all listen. "Simple precaution! Is that not commonsense?"

No issue affecting taxes so clearly divides the two parties in the U.S. election as healthcare. The two parties, in their platforms, describe very different approaches to healthcare economics. Both use political plastic surgery to cover up ugly truths.

The stakes are huge. Americans spend $2.64 per person for healthcare for each purchasing power equivalent dollar spent by the 33 other countries that make up the Organization for Economic Cooperation and Development. The OECD data shows the U.S. spends $8,233 per capita compared with an average of $3,118 in the other 33 countries.

A growing share of federal tax dollars, in direct spending and in tax breaks, is going to U.S. healthcare as the population ages, even though about one in six Americans lacks health insurance.

America‘s healthcare system, more accurately described as a non-system sick care system, totaled 17.6 percent of the economy in 2010, compared to an average of 9.2 percent in the other 33 countries, as the OECD data shows.

In the United States, total public and private cost of healthcare is significantly greater than the total of corporate and individual income taxes, as well as payroll taxes. For each dollar paid in all three of those taxes in 2010, healthcare came to $1.29.

If we just lowered our costs to those of France, which has universal care in what is widely regarded as one of the best systems if not the best, it would save almost as much money as Americans paid in individual income taxes in 2010. The French spend 6 percentage points less of their economy on healthcare. In the United States, the individual income tax in 2010 came to 6.3 percent of the U. S. economy, the lowest since Truman was president.

Take a look at your pay stub to get an idea of the kind of money being spent on a system that fosters bankruptcy, bedevils small business and ranks 31st among the 34 OECD countries in preventing premature death.

REPUBLICAN PLAN

The Republicans say the federal government is “structurally and financially broken” and that “three programs - Medicare, Medicaid, and Social Security – account for over 40 percent of total spending,” which is “harming job creation and growth, (while) projections of future spending growth are nothing short of catastrophic, both economically and socially.”

The Republicans promise to “empower millions of seniors to control their personal healthcare decisions,” a vow immediately followed by a promise to cut federal spending.

The clearest explanation of what that would mean comes from Representative Paul Ryan, the Republican vice presidential nominee. Before he started obfuscating, Ryan laid out his plans in detail. He boasted that by changing Medicare from a plan that provides treatment for every older American into one that gives seniors a fixed sum to buy their own health insurance, taxpayers would save through 2084 the present equivalent of $4.9 trillion.

What Ryan did not mention is that his plan would also mean $8 of increased private spending by seniors and the disabled for each tax dollar saved.

We know how Ryan’s plan would raise total costs because David Rosnick and Dean Baker, economists at the Center for Economic Policy and Research which promotes government policies that it says would benefit workers and the poor, used the same formula that Ryan (or his staff) applied to the same Congressional Budget Office data, but on private medical care spending. Ryan’s spokesman did not respond to requests for comment.

Beyond the fact that it makes no sense to spend $8 to save $1, older people do not have the money. A tenth of Americans age 75 and older live below the official poverty line. Another 24 percent have only saved a tad more.

Every indicator shows that Americans have not enough for their old age and that a shrinking number have pensions while the Republicans now in charge of the party want to cut Social Security benefits, if not kill the program.

So why would any Americans under age 55, whose healthcare benefits Ryan wants to cut when they reach 65, think they can afford to spend $8 to save $1? Recently Ryan has softened his plan to let those who wish stay in traditional Medicare. Since anyone not rich who can count would stick with Medicare, Ryan’s promised taxpayer savings would never materialize.

Alan Grayson, the combative one-term Democratic representative from Florida, got it right when he said on the House floor in 2009: “The Republican plan – don’t get sick and if you do get sick die quickly.”

DEMOCRATS FAVOR UNIVERSAL CARE

The Democratic platform calls for universal healthcare. “We will end the outrage of unaffordable, unavailable healthcare,” they say, though after six decades that party promise remains unfulfilled.

President Barack Obama‘s Patient Protection and Affordable Care Act will enable those with pre-existing conditions and twenty-somethings without work to get health insurance. But the plan does nothing to address the larger economic problem. American healthcare costs too much and needs replacement, not a nip and tuck.

Portugal, with half the income per person as America, provides universal healthcare. Cuba, the CIA tells us, ranks 40th in infant mortality, while the United States is nine steps lower at 49th, an astonishing fact given U.S. spending compared to the poverty induced by Castro’s collectivist economic policies.

Doing worse than Portugal and Cuba is, in my view, not just costly but immoral.

Just as Republicans are trying to limit the franchise, so are they trying to limit who gets healthcare. The Democrats are better only because they recognize that universal care can be cheaper while removing an annoying and costly distraction from business.

Death and taxes will always be with us. What we need is to spend less on taxes while doing the best we can to stave off death.